Traditional MedicarePrior AuthMedium impact
Amvuttra™ (vutrisiran) (Revised)
Humana·KY, SC · Neurology, Cardiology·Medicaid
Effective date
May 28, 2025
We identified it
Jun 24, 2026
Summary
Humana has updated prior authorization criteria for Amvuttra (vutrisiran) injections used to treat hereditary transthyretin-mediated amyloidosis affecting the nervous system and heart. The policy now covers both polyneuropathy (ATTR-PN) and cardiomyopathy (ATTR-CM) forms with specific clinical criteria that must be documented for approval.
Action Required
By May 28, 2025: Billing team must implement prior authorization requirements for Amvuttra (vutrisiran) subcutaneous injections for Medicare and Medicaid patients in Kentucky and South Carolina. Providers treating ATTR-PN must document TTR gene mutation, comprehensive neurologic examination ruling out other causes, polyneuropathy disability score of IIIb or lower, and no history of liver transplant. For ATTR-CM patients, document specialist treatment, NYHA Class I-III heart failure, cardiac involvement confirmed by echo/MRI, and transthyretin protein presence via immunohistochemical analysis or biopsy. Claims will be denied without proper prior authorization and documentation.