MedicaidPrior AuthLow impact
Ryplazim (plasminogen, human-tvmh). (New)
Humana·IN · Hematology·Medicaid
Effective date
Feb 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Indiana has established a new prior authorization policy for Ryplazim (plasminogen, human-tvmh), a rare plasma-derived treatment for Type 1 plasminogen deficiency. The policy requires hematologist involvement, specific diagnostic criteria, and documentation of baseline plasminogen activity levels below 45%.
Action Required
Before February 1, 2026: Billing team must update prior authorization system to flag Ryplazim requests for Indiana Medicaid patients. Ensure providers document: hematologist consultation, Type 1 plasminogen deficiency diagnosis, baseline plasminogen activity ≤45%, and history of hypoplasminogenemia lesions. Create workflow checklist for rare disease documentation requirements.