MedicaidPrior AuthMedium impact
Vyvgart® Hytrulo (efgartigimod alfa and hyaluronidase-qvfc) (New)
Humana·FL · Neurology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 25, 2026
Summary
Humana Florida Medicaid has released a NEW prior authorization policy (effective January 1, 2026) for Vyvgart® Hytrulo (efgartigimod alfa and hyaluronidase-qvfc), covering two rare neurological conditions: generalized myasthenia gravis (gMG) and chronic inflammatory demyelinating polyneuropathy (CIDP). Prior authorization is now REQUIRED before dispensing this medication. The policy establishes specific clinical criteria that must be met for coverage approval, including confirmed diagnosis, specialist involvement, and for gMG, documented anti-AChR antibody positivity.
Action Required
By December 31, 2025: (1) Billing team must implement prior authorization workflow in billing system for Vyvgart Hytrulo subcutaneous solution and syringe under Florida Medicaid. (2) Create authorization checklist requiring: confirmed gMG or CIDP diagnosis, anti-AChR antibody confirmation (gMG only), and documentation of specialist (neurologist) supervision. (3) Update prior auth submission templates to include all three clinical criteria. (4) Train billing and front-desk staff on new authorization requirements. (5) Brief providers on documentation needed for PA requests (diagnosis confirmation, antibody status for gMG, specialist name/credentials). Claims submitted without prior authorization will be denied by Humana Florida Medicaid effective January 1, 2026.