Medicare AdvantagePrior AuthLow impact
Agamree® (vamorolone) (Revised)
Humana·Neurology, Pediatrics·Medicare Advantage
Effective date
May 22, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has implemented new prior authorization requirements for Agamree (vamorolone) for Duchenne Muscular Dystrophy patients. The medication requires specific criteria including confirmed DMD diagnosis, specialist prescriber, ambulatory status, and previous prednisone treatment with adverse effects.
Action Required
Immediately: Billing team must ensure prior authorization is obtained for all Agamree (vamorolone) prescriptions for Medicare Advantage patients. Verify patients meet all four criteria: confirmed DMD diagnosis with genetic testing, specialist prescriber (neurologist/neuromuscular specialist), ambulatory status, and previous 6+ month prednisone treatment with growth or behavioral issues. Claims will be denied without proper prior authorization.