Medicare AdvantagePrior AuthMedium impact
Takhzyro (lanadelumab-flyo) (Revised)
Humana·KY, SC · Allergy & Immunology·Medicaid
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana has updated prior authorization requirements for Takhzyro (lanadelumab-flyo) for hereditary angioedema prophylaxis, adding new C1q level documentation requirements and clarifying step therapy exemptions for different plan types. The policy now requires additional lab documentation including C1q levels to distinguish between HAE and acquired C1INH deficiency.
Action Required
By January 1, 2025: Billing team must update prior authorization requests for Takhzyro to include C1q level documentation in lab reports or medical records. Providers treating hereditary angioedema must ensure all 8 criteria are met, including new C1q level requirements (Criteria #6). Update prior auth checklists to include C1q documentation requirement. Note step therapy exemptions: Medicaid requests do not require Haegarda trial, Medicare Part B requests exempt if continuation within 365 days.