MedicaidPrior AuthLow impact
Givlaari® (givosiran) (New)
Humana·OH · Gastroenterology, Hematology, Genetics +1 more·Medicaid
Effective date
Oct 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has implemented a new prior authorization requirement for Givlaari (givosiran), a specialized medication for treating acute hepatic porphyria. Providers must obtain prior authorization before prescribing this subcutaneous injection, meeting specific diagnostic and symptom criteria.
Action Required
By October 1, 2025: Billing team must update prior authorization procedures for Givlaari (givosiran) prescriptions for Ohio Medicaid patients. Ensure providers document diagnosis confirmation via elevated porphobilinogen/aminolevulinic acid levels or genetic testing, symptom history consistent with acute hepatic porphyria, and healthcare professional administration. Submit prior authorization requests through Humana's system before prescribing. Claims will be denied without proper prior authorization.