MedicaidPrior AuthLow impact
Empaveli (pegcetacoplan) (Revised)
Humana·KY, SC, VA · Hematology, Nephrology·Medicaid
Effective date
Jan 1, 2024
We identified it
Jun 24, 2026
Summary
Humana revised prior authorization criteria for Empaveli (pegcetacoplan), a specialty drug for rare blood and kidney disorders. The policy now covers two conditions: Paroxysmal Nocturnal Hemoglobinuria (PNH) and Complement 3 Glomerulopathy/IC-MPGN, with specific clinical criteria and documentation requirements for approval.
Action Required
Review current Empaveli (pegcetacoplan) prescriptions to ensure proper prior authorization documentation is in place. Verify patients meet revised clinical criteria including specific lab values, clone sizes, and treatment history requirements. Contact Humana for reauthorization if current approvals don't align with new criteria.