MedicaidPrior AuthLow impact
Ruconest (C1 esterase inhibitor, recombinant) (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 Ruconest (C1 esterase inhibitor, recombinant) effective October 1, 2025. This medication treats acute hereditary angioedema (HAE) attacks and requires comprehensive documentation including lab values, specialist treatment, and specific diagnostic criteria for approval.
Action Required
By October 1, 2025: Billing team must update prior authorization requirements for Ruconest in patients with hereditary angioedema. Ensure providers obtain prior auth with complete documentation including C4 levels, C1INH levels, C1q levels, specialist treatment confirmation, and medical records showing recurrent angioedema history. Claims will be denied without proper prior authorization.