Medicare AdvantagePrior AuthMedium impact
Varizig (varicella zoster immune globulin) (Revised)
Humana·Allergy & Immunology, Infectious Disease, Pediatrics +3 more·Medicare Advantage
Effective date
Jan 1, 2024
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its Varizig (varicella zoster immune globulin) pharmacy coverage policy, effective January 1, 2024 with updates as of February 25, 2026. This is a prior authorization policy requiring verification that patients meet specific high-risk criteria before Varizig is covered for post-exposure varicella zoster prophylaxis. Billing teams must ensure all Varizig claims include prior authorization documentation confirming the patient's high-risk status.
Action Required
Before submitting any Varizig claims to Humana Medicare Advantage: (1) Billing team must verify that prior authorization has been obtained before processing claims—this policy requires PA for all Varizig requests; (2) Obtain or verify prior auth by confirming the patient meets at least ONE high-risk criterion (immunocompromised status, newborn of varicella-positive mother, premature infant, <1 year old, pregnant, or adult without evidence of immunity); (3) Document in the claim submission that the patient meets high-risk criteria and that exposure occurred within 10 days (ideally within 96 hours); (4) Update billing workflows to flag all Varizig requests as requiring PA before claim submission—claims submitted without prior authorization will be denied; (5) Refer providers to www.humana.com/PAL for specific medical billing codes and PA submission instructions. Note: This policy specifies that Varizig is NOT indicated for prophylactic use in immunodeficient patients with past varicella history (unless bone marrow transplant planned), so verify indication carefully before authorizing.