Medicare AdvantagePrior AuthLow impact
Rivfloza® (nedosiran) (Revised)
Humana·Nephrology, Urology, Genetics +1 more·Medicare Advantage
Effective date
May 22, 2024
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Rivfloza (nedosiran) for Medicare Advantage plans requires specific diagnostic criteria, specialist prescription, and elevated oxalate levels for Primary Hyperoxaluria Type 1 patients. Initial approvals are for 6 months with renewal requiring clinical response documentation.
Action Required
Immediately: Billing team must ensure prior authorization is obtained for all Rivfloza (nedosiran) prescriptions for Medicare Advantage patients. Providers must document genetic testing or liver biopsy confirmation of PH1, elevated oxalate levels, and prescription by specialist. For renewals, document clinical response showing reduced oxalate levels. Claims will be denied without proper prior authorization.