Traditional MedicarePrior AuthMedium impact
Alpha-1 Proteinase Inhibitors (Aralast NP®, Glassia®, Prolastin-C®) (Revised)
Humana·KY, SC · Pulmonology, Internal Medicine, Family Medicine·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
This is a revised prior authorization policy for Alpha-1 Proteinase Inhibitors (Aralast NP, Glassia, Prolastin-C) for treating congenital alpha1-antitrypsin deficiency with emphysema. The policy establishes specific criteria including diagnosis confirmation, phenotype requirements, serum concentration thresholds, and step therapy requirements for Medicare members.
Action Required
By January 1, 2026: Billing team must ensure prior authorization is obtained for all Alpha-1 Proteinase Inhibitor prescriptions (Aralast NP, Glassia, Prolastin-C) for Medicaid members in Kentucky and South Carolina, and Medicare members. Verify patients meet all four criteria: diagnosis of congenital alpha1-antitrypsin deficiency with emphysema, specific phenotypes (PiZZ, PiZ(null), or Pi(null,null)), serum alpha1-antitrypsin concentrations below specified thresholds, and for Medicare requests, prior therapy with Zemaira or documented intolerance/contraindication. Claims will be denied without proper prior authorization.