MedicaidPrior AuthLow impact
Ryplazim (plasminogen, human-tvmh) (New)
Humana·OH · Hematology·Medicaid
Effective date
Feb 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has implemented a new prior authorization policy for Ryplazim (plasminogen, human-tvmh), a rare disease treatment for plasminogen deficiency type 1. The policy requires hematologist prescription, specific diagnosis confirmation, baseline plasminogen activity levels ≤45%, and documented history of associated lesions.
Action Required
Before February 1, 2026: Billing team must update prior authorization system to require pre-approval for Ryplazim (plasminogen, human-tvmh) for Ohio Medicaid patients. Providers treating plasminogen deficiency must ensure hematologist consultation, baseline plasminogen activity documentation ≤45%, and lesion history documentation before prescribing. Claims will be denied without proper prior authorization.