Medicare AdvantagePrior AuthMedium impact
Berinert (C1 esterase inhibitor, human) (Revised)
Humana·KY, SC · Allergy & Immunology, Emergency Medicine·Medicaid
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana updated their prior authorization policy for Berinert (C1 esterase inhibitor) used to treat hereditary angioedema attacks. The policy now requires step therapy with generic icatibant before approving Berinert, except for Medicare Part B continuations within 365 days and all Medicaid requests.
Action Required
By January 1, 2025: Update prior authorization workflows to include step therapy requirement with generic icatibant before requesting Berinert for hereditary angioedema treatment. Ensure documentation of icatibant trial, contraindication, or intolerance is included in all authorization requests. Note exceptions for Medicare Part B continuations within 365 days and Medicaid requests which are exempt from step therapy.