Medicare AdvantagePrior AuthMedium impact
Andembry ® (garadacimab-gxii) (New)
Humana·Allergy & Immunology·Medicare Advantage
Effective date
Jul 23, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has established a new prior authorization policy for Andembry (garadacimab-gxii), a specialty medication for hereditary angioedema prophylaxis. This medication requires extensive documentation including specific lab values, specialist treatment, and prior trial of Haegarda before approval.
Action Required
By July 23, 2025: Billing team must update prior authorization requirements for Andembry (garadacimab-gxii) in billing system for Humana Medicare Advantage patients. Providers must ensure all 8 criteria are documented including HAE diagnosis confirmation, lab values (C4, C1INH levels, C1q), specialist treatment by allergist/immunologist, and prior Haegarda trial/contraindication before prescribing. Claims will be denied without proper prior authorization.