MedicaidPrior AuthLow impact
Nulibry™ (fosdenopterin) (New)
Humana·IN · Pediatrics, Neurology, Genetics·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Indiana Medicaid has established a new prior authorization policy for Nulibry (fosdenopterin), a specialty drug for treating molybdenum cofactor deficiency Type A. This is a rare genetic disorder medication requiring IV administration with specific genetic testing criteria for approval.
Action Required
By January 1, 2026: Billing team must update prior authorization system to require approval for Nulibry (fosdenopterin) for Indiana Medicaid patients. Providers must document either pending genetic testing with presumed MoCD Type A diagnosis based on symptoms and biochemical testing, or confirmed genetic testing showing MOCS1 gene mutation. Claims will be denied without proper prior authorization.