Medicare AdvantagePrior AuthMedium impact
Yuviwel® (navepegritide) subcutaneous solution (New)
Humana·Endocrinology, Pediatrics, Genetics·Medicare Advantage
Effective date
Apr 22, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has issued a new prior authorization policy for Yuviwel® (navepegritide) effective April 22, 2026, for pediatric patients 2+ years old with genetically confirmed achondroplasia and open epiphyses. All prescriptions require provider attestation of diagnosis, imaging confirmation of open epiphyses, and specialist involvement (endocrinologist or achondroplasia specialist). This is a completely new coverage pathway requiring immediate workflow updates.
Action Required
By April 22, 2026: (1) Billing team must implement prior authorization requirement in claims system for all Yuviwel (navepegritide) subcutaneous solution prescriptions on Medicare Advantage plans. (2) Providers must obtain prior authorization BEFORE dispensing medication; establish template requiring: provider attestation of genetically confirmed achondroplasia diagnosis, diagnostic imaging confirmation that epiphyses are open, and confirmation that prescriber is/consulted with endocrinologist or achondroplasia specialist. (3) Update encounter forms and EMR templates to capture required documentation elements. (4) Front desk/authorization staff must verify all three criteria are met before submitting PA request to Humana. (5) Route all Yuviwel authorizations through specialized pediatric/endocrinology pathway given rare indication. Claims submitted without prior authorization or missing required clinical documentation will be denied. Refer providers to www.humana.com/PAL for applicable medical/procedural coding information.