Medicare AdvantagePrior AuthLow impact
Cinryze (C1 esterase inhibitor, human) (Revised)
Humana·KY, SC · Allergy & Immunology·Medicaid
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana updated prior authorization requirements for Cinryze (C1 esterase inhibitor) used for hereditary angioedema prophylaxis, effective January 1, 2025. The policy now requires step therapy with Haegarda first (except for Medicaid and Medicare Part B continuation cases) and adds specific C1q lab documentation requirements.
Action Required
Immediately: Update prior authorization workflows for Cinryze requests to include new step therapy requirement with Haegarda documentation and C1q lab value requirements. Ensure providers document trial/contraindication/intolerance to Haegarda before requesting Cinryze authorization. Note exceptions for Medicaid requests (no step therapy) and Medicare Part B continuation within 365 days.