MedicaidPrior AuthLow impact
Alpha-1 Proteinase Inhibitors (Aralast NP®, Glassia®, Prolastin-C®, Zemaira®) (Revised)
Humana·IN · Pulmonology, Internal Medicine·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Indiana has revised prior authorization requirements for Alpha-1 Proteinase Inhibitors (Aralast NP, Glassia, Prolastin-C, Zemaira) with specific criteria for congenital alpha1-antitrypsin deficiency with emphysema. The policy requires documented diagnosis, specific phenotypes, and serum concentration levels, while excluding IgA deficient patients.
Action Required
By January 1, 2026: Billing team must ensure prior authorization requests for Alpha-1 Proteinase Inhibitors include documentation of congenital alpha1-antitrypsin deficiency with emphysema, specific phenotype results (PiZZ, PiZ(null), or Pi(null,null)), and initial serum alpha1-antitrypsin concentrations below specified thresholds. Update prior auth checklists to verify patients are not IgA deficient. Claims will be denied without meeting all three criteria.