MedicaidPrior AuthLow impact
Luxturna® (voretigene neparvovec-rzyl) (New)
Humana·OH · Ophthalmology, Genetics·Medicaid
Effective date
Feb 1, 2026
We identified it
Jun 24, 2026
Summary
Humana is implementing a new prior authorization policy for Luxturna (voretigene neparvovec-rzyl), a specialized gene therapy for RPE65 mutation-associated retinal dystrophy. This one-time subretinal injection requires extensive documentation including genetic testing confirmation, age requirements (12 months to 65 years), and proof of viable retinal cells.
Action Required
By February 1, 2026: Ophthalmology and genetics providers must ensure prior authorization is obtained for Luxturna therapy. Update billing workflows to require genetic testing documentation confirming biallelic RPE65 mutation, age verification, and retinal viability assessment before submitting claims. Claims will require 6-month approval renewals.