MedicaidPrior AuthLow impact
Gamifant® (emapalumab-lzsg) (New)
Humana·LA · Hematology, Oncology, Pediatrics +1 more·Medicaid
Effective date
Nov 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Louisiana Medicaid has established a new prior authorization policy for Gamifant (emapalumab-lzsg), a specialty drug for treating primary hemophagocytic lymphohistiocytosis (HLH) and HLH/macrophage activation syndrome (MAS). This policy requires specific clinical criteria to be met and documented before coverage approval.
Action Required
By November 1, 2025: Billing and clinical teams must implement prior authorization requirements for Gamifant (emapalumab-lzsg) for Louisiana Medicaid patients. Providers must document specific clinical criteria including genetic mutations, clinical characteristics, treatment history, and stem cell transplant candidacy. Update billing workflows to obtain prior auth before prescribing. Claims without prior authorization will be denied.