Traditional MedicarePrior AuthLow impact
VPRIV® (velaglucerase alfa) (Revised)
Humana·KY, SC · Hematology, Genetics, Pediatrics +1 more·Medicaid
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana has established a revised prior authorization policy for VPRIV (velaglucerase alfa) effective January 1, 2025, requiring Type 1 Gaucher's Disease diagnosis and prior therapy with Elelyso (with exceptions for Medicare Part B continuations). This is an enzyme replacement therapy requiring step therapy documentation for approval.
Action Required
Immediately: Billing team must ensure prior authorization is obtained for all VPRIV (velaglucerase alfa) requests by verifying patient has Type 1 Gaucher's Disease diagnosis and documenting prior therapy/intolerance/contraindication to Elelyso before submitting claims. For Medicare Part B continuation requests within past 365 days, step therapy requirement is waived. Update prior auth checklists to include these specific criteria.