Medicare AdvantagePrior AuthMedium impact
Firazyr (icatibant) (Revised)
Humana·FL, KY · Allergy & Immunology, Emergency Medicine, Internal Medicine·Medicaid
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana updated prior authorization criteria for Firazyr (icatibant) and generic equivalents used to treat hereditary angioedema. The policy now requires more specific lab documentation including C1q levels and adds step therapy requirements for brand Firazyr with exceptions for Medicaid patients.
Action Required
Immediately: Update prior authorization forms and workflows for Firazyr/icatibant requests to include new required lab values (C1q levels, C4, C1INH levels) and ensure specialist documentation from allergist/immunologist is obtained. For brand Firazyr requests, document generic icatibant trial or intolerance except for Medicaid patients. Claims will be denied without complete lab documentation and specialist involvement.