MedicaidPrior AuthLow impact
Berinert (C1 esterase inhibitor, human) (New)
Humana·IN · Allergy & Immunology·Medicaid
Effective date
Oct 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid Indiana has established a new prior authorization policy for Berinert (C1 esterase inhibitor) for treating hereditary angioedema (HAE) attacks, effective October 1, 2025. The policy requires extensive clinical documentation including specific lab values, specialist treatment, and diagnosis confirmation before approval.
Action Required
Before October 1, 2025: Billing team must implement prior authorization requirements for Berinert prescriptions for Indiana Medicaid patients. Update system to flag HAE patients requiring specialist documentation, C1 inhibitor levels, C4 levels, C1q levels, and confirmation of treatment by allergist/immunologist. Claims will be denied without proper prior authorization.