MedicaidPrior AuthMedium impact
Tysabri® (natalizumab) (New)
Humana·OH · Neurology, Gastroenterology, Internal Medicine·Medicaid
Effective date
Dec 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has established a new prior authorization policy for Tysabri (natalizumab) effective December 1, 2025, covering multiple sclerosis and Crohn's disease treatments. This requires prior authorization approval before administering this IV medication for qualifying patients.
Action Required
By December 1, 2025: Billing team must implement prior authorization requirements for Tysabri (natalizumab) infusions for Humana Medicaid Ohio patients. Update billing system to flag these cases and create workflow for providers to obtain prior auth before treatment. Ensure documentation includes diagnosis of relapsing MS forms or moderate-to-severe Crohn's disease with evidence of prior anti-TNF therapy failure. Claims will be denied without proper prior authorization.