MedicaidPrior AuthLow impact
Evkeeza™ (evinacumab-dgnb) (Revised)
Humana·OH · Cardiology, Endocrinology, Pediatrics·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has implemented a new prior authorization policy for Evkeeza (evinacumab-dgnb), an IV medication for treating Homozygous Familial Hypercholesterolemia (HoFH). Prior authorization will be required for this specialty cholesterol medication starting January 1, 2026.
Action Required
By January 1, 2026: Billing team must update prior authorization requirements for Evkeeza (evinacumab-dgnb) for Humana Medicaid Ohio patients. Providers must verify patients meet specific diagnostic criteria including genetic testing or untreated LDL-C >400 mg/dL plus clinical features, and current LDL-C >70 mg/dL despite maximum lipid-lowering therapy. Visit www.humana.com/PAL for medical coding information and prior authorization forms.