Traditional MedicarePrior AuthLow impact
Cerezyme® (imiglucerase) (Revised)
Humana·KY, SC · Hematology, Endocrinology, Genetics +1 more·Medicaid
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana has revised their prior authorization policy for Cerezyme (imiglucerase), an enzyme replacement therapy for Type 1 and Type 3 Gaucher disease. The policy requires step therapy with Elelyso first for Type 1 Gaucher disease patients (except Medicare Part B continuation cases), while Type 3 patients can access Cerezyme directly for non-CNS manifestations.
Action Required
By January 1, 2025: Medical billing team must ensure prior authorization is obtained for all Cerezyme (imiglucerase) requests. For Type 1 Gaucher disease patients, document previous treatment with, contraindication to, or intolerance of Elelyso (taliglucerase alfa) unless this is a Medicare Part B continuation within 365 days. Update prior authorization workflow to verify non-CNS manifestations for both Type 1 and Type 3 Gaucher disease. Claims without proper prior authorization will be denied.