Medicare AdvantagePrior AuthLow impact
Rystiggo (rozanolixizumab-noli) (Revised)
Humana·KY, SC · Neurology·Medicaid
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana has implemented a new prior authorization policy for Rystiggo (rozanolixizumab-noli), a subcutaneous treatment for generalized myasthenia gravis. The policy requires specialist supervision and step therapy requirements that differ between Medicare Part D, Part B, and Medicaid plans.
Action Required
By January 1, 2025: Billing team must verify prior authorization requirements for Rystiggo (rozanolixizumab-noli) prescriptions. For Medicare Part D requests, confirm patient has tried Vyvgart products. For Medicare Part B, also verify trial of Ultomiris. For Medicaid, confirm trial of pyridostigmine and immunosuppressive therapy. Update authorization request protocols to include required antibody testing documentation (anti-AChR or anti-MuSK). Ensure specialist supervision documentation is available.