Traditional MedicarePrior AuthMedium impact
Imaavy intravenous solution (nipocalimab-aahu) (New)
Humana·KY, SC, 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), a specialty IV medication for generalized myasthenia gravis. This affects Medicare and Medicaid plans in Kentucky, South Carolina, and Virginia, requiring specific diagnostic criteria and step therapy documentation before approval.
Action Required
By October 22, 2025: Billing team must update prior authorization systems to include Imaavy (nipocalimab-aahu) for generalized myasthenia gravis patients on Medicare and Medicaid plans in Kentucky, South Carolina, and Virginia. Providers must document antibody test results (AChR or MuSK positive), specialist management, and prior therapy trials with specific medications based on plan type. Claims will be denied without proper prior authorization.