Medicare AdvantagePrior AuthLow impact
Pombiliti® (cipaglucosidase alfa-atga) (Revised)
Humana·KY, SC · Endocrinology, Neurology, Genetics·Medicaid
Effective date
Mar 27, 2024
We identified it
Jun 24, 2026
Summary
Humana has revised its prior authorization policy for Pombiliti (cipaglucosidase alfa-atga), a specialized enzyme replacement therapy for late-onset Pompe disease. The policy requires patients to be 18+ years old, weigh 40kg or more, not be improving on current enzyme replacement therapy, and use Pombiliti in combination with Opfolda.
Action Required
Immediately: Review patients currently prescribed Pombiliti for late-onset Pompe disease to ensure prior authorization documentation includes all five criteria: diagnosis confirmation, age 18+, weight 40kg+, lack of improvement on current ERT, and combination use with Opfolda. Update prior authorization request forms to include these specific requirements for Humana Medicare and Medicaid plans in Kentucky and South Carolina.