MedicaidPrior AuthMedium impact
Wainua™ (eplontersen) (New)
Humana·OH · Neurology, Internal Medicine, Genetics·Medicaid
Effective date
Jun 1, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicaid Ohio has launched a new prior authorization policy for Wainua (eplontersen), an antisense oligonucleotide treatment for hereditary transthyretin-mediated amyloidosis with polyneuropathy. Effective June 1, 2026, all prescriptions require prior authorization and must meet four clinical criteria: documented TTR gene mutation, confirmed polyneuropathy with ruled-out alternative causes, polyneuropathy disability score ≤IIIb, and no prior liver transplant history.
Action Required
By May 15, 2026: Billing and clinical teams must establish prior authorization workflow for Wainua (eplontersen) in all systems. (1) Pharmacy staff: Create PA submission template requiring documentation of: TTR gene mutation confirmation, neurologic exam findings ruling out other neuropathy causes, polyneuropathy disability score (IIIb or lower), and confirmation of no prior liver transplant. (2) Billing team: Flag all Wainua prescriptions in billing software to require PA completion before claim submission; do not process claims without prior auth approval. (3) Providers: Update prescription templates and EMR to include required clinical documentation fields. (4) Contact Humana at applicable PAL (Preauthorization and Notification List) portal to confirm submission process. Consequence: Claims submitted without prior authorization will be denied by Humana Medicaid Ohio.