Medicare AdvantagePrior AuthLow impact
Panhematin® (heme for injection) intravenous solution (New)
Humana·FL, KY, VA · Hematology, Internal Medicine, Family Medicine·Medicaid
Effective date
Aug 27, 2025
We identified it
Jun 24, 2026
Summary
Humana has implemented a new prior authorization policy for Panhematin (heme for injection) effective August 27, 2025, requiring specific clinical criteria for acute intermittent porphyria treatment. The policy applies to Medicare and Medicaid plans in Florida, Kentucky, and Virginia and requires confirmation of diagnosis through quantitative PBG measurement and evidence of failed/inadequate carbohydrate therapy.
Action Required
By August 27, 2025: Billing team must implement prior authorization process for Panhematin prescriptions for Humana Medicare and Medicaid members in FL, KY, and VA. Providers must document: (1) use for menstrual cycle-related acute intermittent porphyria attacks, (2) confirmed diagnosis via quantitative PBG urine measurement, and (3) failed carbohydrate therapy or provider clinical judgment that it would be inadequate. Visit www.humana.com/PAL for specific medical coding requirements.