MedicaidPrior AuthLow impact
Firazyr (icatibant) (New)
Humana·IN · Allergy & Immunology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Indiana has implemented a new prior authorization policy for Firazyr (icatibant) and related medications used to treat hereditary angioedema (HAE). The policy requires extensive documentation including lab values, specialist treatment, and specific clinical criteria to be met before approval.
Action Required
By January 1, 2026: Billing team must implement prior authorization requirements for Firazyr (icatibant) and Sajazir subcutaneous syringes for Indiana Medicaid patients. Ensure providers document all required criteria including C4 levels, C1 inhibitor levels, C1q levels, HAE diagnosis type 1 or 2, and specialist treatment by allergist/immunologist. Claims will be denied without proper prior authorization and documentation.