MedicaidPrior AuthMedium impact
Vimizim® (elosulfase alfa) (New)
Humana·IN · Genetics, Pediatrics, Internal Medicine·Medicaid
Effective date
Mar 1, 2026
We identified it
Jun 25, 2026
Summary
Humana Indiana Medicaid has established a new prior authorization policy for Vimizim® (elosulfase alfa) effective March 1, 2026. This is a pharmacy coverage policy requiring prior authorization for this intravenous enzyme replacement therapy used to treat Mucopolysaccharidosis IVA (MPS IVA; Morquio A Syndrome). The sole approval criterion is diagnosis confirmation of MPS IVA, with initial and renewal approvals granted for plan year durations.
Action Required
By March 1, 2026: Billing team must implement prior authorization requirement for all Vimizim (elosulfase alfa) claims submitted to Humana Indiana Medicaid. Add this medication to the practice's pharmacy prior authorization checklist and alert prescribers that PA requests must include documented diagnosis of MPS IVA (Morquio A Syndrome) before dispensing. Verify member eligibility and obtain PA approval before claims submission. Update pharmacy benefit manager communication protocols to include this new requirement. Alert relevant clinical staff about the Black Box Warning for anaphylaxis risk and ensure patients receive appropriate monitoring instructions during infusions. Coordinate with billing software vendor to configure PA workflow if using automated systems. Failure to obtain prior authorization will result in claim denials.