MedicaidPrior AuthMedium impact
Aduhelm (aducanumab-avwa) (New)
Humana·OH · Neurology, Geriatrics, Internal Medicine +1 more·Medicaid
Effective date
Nov 26, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has established a new prior authorization policy for Aduhelm (aducanumab-avwa), an Alzheimer's disease treatment requiring extensive documentation including cognitive assessments, amyloid imaging, and neurological evaluations. The policy includes 13 initial criteria and 13 renewal criteria with strict monitoring requirements for brain imaging abnormalities.
Action Required
By November 26, 2025: Billing team must update prior authorization system to require comprehensive documentation for Aduhelm including MMSE/CDR/MoCA scores, amyloid PET or CSF results, MRI imaging, and neurologist attestations for ARIA monitoring. Providers must obtain in-person evaluations and submit assessment forms with chart notes. Claims will be denied without complete documentation meeting all 13 criteria.