MedicaidPrior AuthMedium impact
Saphnelo™ (anifrolumab-fnia) (Revised)
Humana·OH · Rheumatology, Internal Medicine·Medicaid
Effective date
Nov 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has established new prior authorization requirements for Saphnelo (anifrolumab-fnia) for systemic lupus erythematosus treatment. The policy requires specific diagnostic criteria, positive autoantibodies, use with standard treatments, and prescribing by SLE specialists.
Action Required
Before November 1, 2025: Billing team must establish prior authorization workflow for Saphnelo (anifrolumab-fnia) for Humana Medicaid Ohio patients. Providers must document moderate to severe SLE diagnosis, positive autoantibodies (ANA, anti-ds DNA, anti-Sm), concurrent standard treatments, absence of severe lupus nephritis/CNS involvement, and specialist prescribing. Update EMR templates to capture required criteria. Claims will be denied without prior authorization.