Medicare AdvantagePrior AuthMedium impact
Zavesca® (miglustat) (Revised)
Humana·Genetics, Hematology, Internal Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has updated its Zavesca (miglustat) prior authorization policy effective January 1, 2025, with a revision dated January 28, 2026. The policy requires prior authorization for miglustat use in Medicare Advantage members with type 1 Gaucher disease who have failed or are intolerant to Elelyso (taliglucerase) therapy. Coverage is approved in plan year durations for both initial and renewal requests.
Action Required
By January 1, 2025: Billing team must implement prior authorization requirement for Zavesca (miglustat), Yargesa (miglustat), and generic miglustat capsules for all Medicare Advantage members. Before submitting claims, obtain prior authorization confirming: (1) member has type 1 Gaucher disease diagnosis, and (2) member has prior therapy, contraindication, or intolerance to Elelyso (taliglucerase). Update claim submission workflows to route miglustat requests to Humana's preauthorization system at www.humana.com/PAL. Train front desk and clinical staff on eligibility criteria. Document prior authorization approval on all claims. Failure to obtain required prior authorization will result in claim denials.