Medicare AdvantagePrior AuthLow impact
Cerdelga® (eliglustat) (Revised)
Humana·Endocrinology, Hematology, Genetics·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for Cerdelga (eliglustat) for Gaucher disease type 1 treatment. Approval requires genetic testing confirmation of CYP2D6 metabolizer status and previous treatment with/contraindication to Elelyso.
Action Required
By January 1, 2025: Billing team must implement prior authorization workflow for Cerdelga (eliglustat) prescriptions for Humana Medicare Advantage members. Ensure providers document diagnosis of type 1 Gaucher disease, FDA-approved CYP2D6 genetic test results showing PM/EM/IM status, and previous treatment/contraindication/intolerance with Elelyso before submitting prior auth requests. Claims will be denied without proper authorization.