MedicaidPrior AuthMedium impact
Saphnelo™ (anifrolumab-fnia) (Revised)
Humana·IN · Rheumatology, Internal Medicine·Medicaid
Effective date
Nov 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid Indiana has implemented new prior authorization requirements for Saphnelo (anifrolumab-fnia) for treating moderate to severe systemic lupus erythematosus. Providers must meet 5 specific criteria including diagnosis confirmation, positive autoantibodies, combination with standard treatments, and prescription by lupus specialists.
Action Required
By November 1, 2025: Billing team must implement prior authorization requirements for Saphnelo (anifrolumab-fnia) prescriptions for Humana Medicaid Indiana members. Ensure providers document: 1) moderate to severe SLE diagnosis, 2) positive autoantibodies (ANA, anti-ds DNA, anti-Sm), 3) use with standard treatments (prednisone, hydroxychloroquine, azathioprine), 4) absence of severe lupus nephritis or CNS lupus, 5) prescription by lupus specialist. Update billing system to flag these requirements and visit www.humana.com/PAL for medical coding information.