MedicaidPrior AuthLow impact
Gamifant® (emapalumab-lzsg) (New)
Humana·IN · Hematology, Oncology, Pediatrics +1 more·Medicaid
Effective date
Nov 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid Indiana has established a new prior authorization policy for Gamifant® (emapalumab-lzsg), requiring specific clinical criteria documentation for coverage of this medication used to treat primary hemophagocytic lymphohistiocytosis (HLH) and HLH/macrophage activation syndrome (MAS). The policy requires evidence of gene mutations or specific clinical characteristics, failure of conventional therapy, and candidacy for stem cell transplant.
Action Required
Before November 1, 2025: Providers treating patients with hemophagocytic lymphohistiocytosis must obtain prior authorization for Gamifant® (emapalumab-lzsg) for Humana Medicaid Indiana patients. Ensure documentation includes gene mutation testing or at least 5 specific clinical criteria, evidence of conventional therapy failure, confirmation of dexamethasone co-administration, and stem cell transplant candidacy. Claims without prior authorization will be denied.