MedicaidPrior AuthLow impact
Strensiq® (asfotase alfa) (Revised)
Humana·IN · Endocrinology, Pediatrics, Genetics·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana has established prior authorization requirements for Strensiq (asfotase alfa) subcutaneous injection for Indiana Medicaid members with hypophosphatasia. The policy requires specific diagnostic criteria including clinical/radiographic evidence of early-onset hypophosphatasia and laboratory confirmation through gene mutation testing or elevated biomarkers.
Action Required
By January 1, 2026: For Indiana Medicaid patients requiring Strensiq (asfotase alfa), billing team must obtain prior authorization by documenting: 1) Clinical signs/symptoms or radiographic evidence of hypophosphatasia onset before age 18, 2) Gene mutation testing OR low alkaline phosphatase levels with elevated phosphoethanolamine or pyridoxal 5'-phosphate levels. Ensure providers complete all diagnostic criteria before submitting authorization requests. Claims will be denied without proper prior authorization.