Medicare AdvantagePrior AuthMedium impact
Atgam (antithymocyte immune globulin, equine) (Revised)
Humana·Hematology, Nephrology, Transplant Surgery +1 more·Medicare Advantage
Effective date
Jan 1, 2024
We identified it
Jun 24, 2026
Summary
This is a revised prior authorization policy for Atgam (antithymocyte immune globulin, equine) for Medicare Advantage plans, covering three indications: aplastic anemia, renal transplant rejection, and renal transplant rejection prophylaxis. The policy requires specific clinical criteria to be met and excludes certain patient populations, with approvals limited to 4-week durations.
Action Required
Immediately: Billing team must ensure prior authorization is obtained for all Atgam prescriptions for Medicare Advantage patients before administration. Verify patients meet specific criteria for aplastic anemia (moderate/severe, not suitable for bone marrow transplant), renal transplant rejection, or prophylaxis. Document that excluded conditions (secondary aplastic anemia, myelotoxic exposure) are not present. Approvals are limited to 4 weeks and require renewal.