MedicaidPrior AuthLow impact
Gamifant® (emapalumab-lzsg) (New)
Humana·OH · Hematology, Oncology, Pediatrics +1 more·Medicaid
Effective date
Nov 1, 2025
We identified it
Jun 24, 2026
Summary
Humana has established a new prior authorization policy for Gamifant (emapalumab-lzsg), a specialty medication used to treat primary hemophagocytic lymphohistiocytosis (HLH) and HLH/macrophage activation syndrome (MAS). This policy requires prior authorization with specific clinical criteria including documentation of gene mutations or clinical characteristics, failure of conventional therapy, and candidacy for stem cell transplant.
Action Required
By November 1, 2025: Billing team must ensure prior authorization is obtained before administering Gamifant (emapalumab-lzsg) for Ohio Medicaid patients. Providers must document gene mutations or at least 5 specific clinical criteria, failure of conventional HLH therapy, concurrent dexamethasone administration, and stem cell transplant candidacy. Claims will be denied without proper prior authorization.