Medicare AdvantagePrior AuthLow impact
Dawnzera™ (donidalorsen) (New)
Humana·KY, SC · Allergy & Immunology·Medicaid
Effective date
Oct 22, 2025
We identified it
Jun 24, 2026
Summary
Humana has established a new prior authorization policy for Dawnzera (donidalorsen), a subcutaneous injection for hereditary angioedema (HAE) prophylaxis. The policy requires extensive documentation including specific lab values, specialist treatment, and step therapy with Haegarda (except for Medicaid requests).
Action Required
By October 22, 2025: Billing team must update prior authorization requirements for Dawnzera (donidalorsen) prescriptions. Ensure providers obtain prior auth with required documentation including C4 levels, C1INH levels, C1q levels, HAE diagnosis confirmation, and evidence of Haegarda trial/contraindication (Medicare only). Alert allergy/immunology specialists that step therapy requirements apply for Medicare but not Medicaid patients.