MedicaidPrior AuthLow impact
Pombiliti® (cipaglucosidase alfa-atga) (New)
Humana·OH · Neurology, Genetics, Internal Medicine·Medicaid
Effective date
Feb 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has added a new prior authorization policy for Pombiliti (cipaglucosidase alfa-atga), a treatment for late-onset Pompe disease. The policy requires patients to be 18+ years old, weigh 40kg or more, not be improving on current enzyme replacement therapy, and use Pombiliti in combination with Opfolda.
Action Required
Before February 1, 2026: Billing team must update prior authorization system to require pre-approval for Pombiliti (cipaglucosidase alfa-atga) for Medicaid Ohio patients. Providers must document diagnosis of late-onset Pompe disease, patient age 18+, weight 40kg+, failure to improve on current ERT, and concurrent use with Opfolda. Claims will be denied without proper authorization.