MedicaidPrior AuthLow impact
Luxturna® (voretigene neparvovec-rzyl) (Revised)
Humana·LA · Ophthalmology, Genetics·Medicaid
Effective date
Jan 19, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicaid Louisiana has established prior authorization requirements for Luxturna (voretigene neparvovec-rzyl), a gene therapy for RPE65 mutation-associated retinal dystrophy. Coverage requires specific genetic testing confirmation, age restrictions (12 months to 65 years), and documentation of viable retinal cells, with initial and renewal approvals limited to 6 months each.
Action Required
Immediately: Billing team must implement prior authorization requirements for Luxturna (voretigene neparvovec-rzyl) claims for Louisiana Medicaid patients. Ensure providers document all four required criteria: RPE65 mutation-associated retinal dystrophy diagnosis with clinical testing, positive biallelic RPE65 genetic test, patient age 12 months-65 years, and sufficient viable retinal cells via OCT or other specified methods. Claims without prior authorization will be denied.