Medicare AdvantagePrior AuthMedium impact
Imaavy intravenous solution (nipocalimab-aahu) (New)
Humana·VA · Neurology·Medicaid
Effective date
Oct 22, 2025
We identified it
Jun 24, 2026
Summary
Humana has introduced a new prior authorization policy for Imaavy (nipocalimab-aahu) intravenous solution, a new treatment for generalized myasthenia gravis. The policy requires strict prior authorization with different criteria based on antibody type (AChR vs MuSK positive) and plan type (Medicare vs Medicaid).
Action Required
By October 22, 2025: Billing team must implement prior authorization requirements for Imaavy (nipocalimab-aahu) for generalized myasthenia gravis patients. Providers must document antibody testing (AChR or MuSK positive), specialist supervision, and prior treatment failures per plan-specific criteria. Update EMR templates to capture required documentation. Claims will be denied without proper prior authorization.