MedicaidPrior AuthMedium impact
Zycubo® (copper histidinate) Powder for Injection (New)
Humana·OH · Pediatrics, Pharmacy·Medicaid
Effective date
May 1, 2026
We identified it
Jun 25, 2026
Summary
Humana Ohio Medicaid is implementing a new prior authorization requirement for Zycubo® (copper histidinate) Powder for Injection, effective May 1, 2026. Coverage is limited to pediatric patients (up to age 17) with genetically confirmed Menkes disease (ATP7A gene mutations). Billing teams must establish prior authorization workflows and ensure providers document genetic confirmation before claim submission.
Action Required
By April 15, 2026: Billing team must establish prior authorization workflow for Zycubo® in the billing system. Update provider notification templates to require THREE criteria for PA approval: (1) diagnosis of Menkes disease, (2) genetic confirmation of ATP7A gene mutation (provider attestation required), and (3) member age up to 17 years. Configure system to flag Zycubo® claims for manual review if PA is not obtained. Communicate requirements to pediatric providers and coordinate with clinical staff to ensure genetic testing documentation is attached to PA requests. Claims submitted without prior authorization will be denied. Monitor for approval duration specifications in renewal plan documentation.