Medicare AdvantagePrior AuthLow impact
Thymoglobulin (antithymocyte globulin [rabbit]) (Revised)
Humana·Nephrology, Transplant Surgery·Medicare Advantage
Effective date
Jan 1, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has revised its prior authorization policy for Thymoglobulin (antithymocyte globulin rabbit) used for renal transplant rejection. The policy requires strict criteria including confirmed renal transplant, specific indication for prophylaxis or treatment of acute rejection, combination with conventional therapy, and excludes patients with rabbit protein allergies or active infections.
Action Required
Immediately: Billing and clinical teams must ensure prior authorization is obtained for all Thymoglobulin prescriptions for Medicare Advantage patients. Verify patient meets all four criteria: has received renal transplant, using for prophylaxis/treatment of acute rejection, will be used with conventional therapy, and may need BvsD coverage determination. Document absence of rabbit protein allergies and active infections. Approvals are limited to 2-week durations requiring frequent renewals.