MedicaidPrior AuthMedium impact
Kisunla™ (donanemab-azbt) (Revised)
Humana·KY, SC · Neurology, Geriatrics, Internal Medicine·Medicaid
Effective date
Sep 25, 2024
We identified it
Jun 24, 2026
Summary
Humana has established new prior authorization requirements for Kisunla (donanemab-azbt), an Alzheimer's disease treatment, for Medicaid patients in Kentucky and South Carolina. The policy requires extensive documentation including cognitive assessments, amyloid testing, MRI results, and specialist prescribing.
Action Required
Immediately: Billing team must implement prior authorization process for Kisunla (donanemab-azbt) for Kentucky and South Carolina Medicaid patients. Ensure providers document all 12 criteria including MMSE/MoCA scores, amyloid testing results, MRI reports, ApoE testing consideration, and specialist consultation. Create checklist for required documentation to avoid claim denials. Set up 6-month renewal reminders for continued therapy approvals.