Traditional MedicarePrior AuthMedium impact
Itvisma (onasemnogene abeparvovec-brve)
Humana·FL, SC · Neurology, Pediatrics, Genetics·Medicaid
Effective date
Jan 28, 2026
We identified it
Jun 24, 2026
Summary
Humana has introduced a new prior authorization policy for Itvisma (onasemnogene abeparvovec-brve), a gene therapy for spinal muscular atrophy in patients 2 years and older. This policy requires extensive documentation and approval before treatment for Medicare and Medicaid patients in Florida and South Carolina.
Action Required
By January 28, 2026: Billing team must implement prior authorization requirements for Itvisma (onasemnogene abeparvovec-brve) for Medicare and Medicaid patients in Florida and South Carolina. Update billing system to flag this medication for prior auth. Notify neurologists and specialists treating SMA patients that they must obtain approval before treatment, including documentation of genetic confirmation, antibody titers, and patient functional status. Claims will be denied without proper prior authorization.