MedicaidPrior AuthLow impact
Kanuma® (sebelipase alfa) (New)
Humana·IN · Endocrinology, Gastroenterology, Genetics +1 more·Medicaid
Effective date
Nov 1, 2025
We identified it
Jun 24, 2026
Summary
Humana has established a new prior authorization policy for Kanuma (sebelipase alfa), a specialized intravenous treatment for Lysosomal Acid Lipase Deficiency (LAL-D). This policy requires confirmation of LAL-D diagnosis through specific testing (DBS, leucocyte, or genetic testing) before approval for this ultra-rare disease treatment.
Action Required
By November 1, 2025: Billing team must implement prior authorization requirements for Kanuma (sebelipase alfa) infusions for Medicaid Indiana patients. Ensure providers document LAL-D diagnosis confirmation via Dried Blood Spot test, leucocyte testing, or genetic testing before submitting requests. Visit www.humana.com/PAL for specific medical and procedural coding information.