Medicare AdvantagePrior AuthLow impact
Miplyffa® (arimoclomol) (Revised)
Humana·Neurology, Genetics, Pediatrics·Medicare Advantage
Effective date
Mar 26, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for Miplyffa (arimoclomol) for treatment of Niemann-Pick disease type C. This ultra-rare disease medication requires specific diagnostic confirmation, combination with miglustat, and specialist prescribing to obtain coverage approval.
Action Required
By March 26, 2025: For any patients with Niemann-Pick disease type C requiring Miplyffa, billing team must ensure providers obtain prior authorization from Humana Medicare Advantage before prescribing. Verify all five criteria are met: confirmed NPC diagnosis with genetic/lab testing, combination with miglustat, neurological symptoms present, and specialist prescribing. Visit www.humana.com/PAL for prior authorization submission process.