Medicare AdvantagePrior AuthLow impact
Opfolda® (miglustat) (Revised)
Humana·Neurology, Genetics, Internal Medicine·Medicare Advantage
Effective date
Mar 27, 2024
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Opfolda® (miglustat) effective March 27, 2024, requiring specific criteria including late-onset Pompe disease diagnosis, age 18+, weight 40kg+, failure on current enzyme replacement therapy, and concurrent use with Pombiliti. This is a Medicare Advantage pharmacy coverage policy with prior authorization requirements.
Action Required
Immediately: Verify Opfolda® (miglustat) requires prior authorization for Medicare Advantage patients. Ensure providers document all five criteria: late-onset Pompe disease diagnosis, patient age 18+, weight 40kg+, failure on current enzyme replacement therapy, and concurrent Pombiliti use. Contact pharmacy team to coordinate prior authorization submissions for affected patients.