Medicare AdvantagePrior AuthMedium impact
PiaSky® (crovalimab-akkz) injection solution (Revised)
Humana·FL, KY, SC · Hematology·Medicaid
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana has established a new prior authorization policy for PiaSky (crovalimab-akkz), a complement C5 inhibitor injection for treating Paroxysmal Nocturnal Hemoglobinuria (PNH). The policy requires specific diagnostic criteria including hematologist involvement, flow cytometry testing, and clinical evidence of hemolysis or transfusion dependence.
Action Required
By January 1, 2025: Billing team must implement prior authorization requirements for PiaSky (crovalimab-akkz) injections for Humana Medicare and Medicaid members in Florida, Kentucky, and South Carolina. Ensure providers document hematologist collaboration, flow cytometry results showing PNH clones, clinical signs of hemolysis or transfusion dependence, patient weight ≥40kg, and for Medicare Part B, document trial or contraindication to Ultomiris unless continuing prior therapy within 365 days.