Medicare AdvantagePrior AuthLow impact
Sucraid® (sacrosidase) (Revised)
Humana·Gastroenterology, Pediatrics, Genetics·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for Sucraid (sacrosidase) oral solution used to treat congenital sucrase-isomaltase deficiency (CSID). The policy requires confirmation of CSID diagnosis through specific testing, specialist prescription, and use with dietary restrictions.
Action Required
By January 1, 2025: Billing team must ensure prior authorization is obtained for all Sucraid (sacrosidase) prescriptions for Medicare Advantage patients. Verify patients have confirmed CSID diagnosis through small bowel biopsy, sucrose breath hydrogen test, or 13C-sucrose breath test. Ensure prescriptions are from gastroenterologists or rare disease specialists. Claims without prior authorization will be denied.