Medicare AdvantagePrior AuthMedium impact
LAMZEDE® (velmanase alfa-tycv) (Revised)
Humana·KY, SC · Genetics, Internal Medicine, Pediatrics·Medicaid
Effective date
Aug 23, 2023
We identified it
Jun 25, 2026
Summary
Humana has revised its LAMZEDE® (velmanase alfa-tycv) pharmacy coverage policy effective August 23, 2023, with most recent updates as of April 22, 2026. This is a Prior Authorization policy covering LAMZEDE for non-central nervous system manifestations of alpha-mannosidosis in Medicare and Medicaid (Kentucky and South Carolina) members. Billing teams must ensure all LAMZEDE claims require prior authorization approval before processing.
Action Required
By April 22, 2026: Billing team must verify this is the most current LAMZEDE policy version by checking www.humana.com/PAL and reviewing Medical and Pharmacy Coverage Policies. For all LAMZEDE (velmanase alfa-tycv) intravenous solution claims submitted for Medicare and Medicaid (KY and SC) members, billing staff must: (1) Confirm member has diagnosis of alpha-mannosidosis requiring treatment for non-central nervous system manifestations; (2) Obtain prior authorization before claim submission; (3) Reference the PAL (Preauthorization and Notification List) at www.humana.com/PAL for applicable medical/procedural coding requirements; (4) Do not rely on printed versions of this policy—always reference the online version. Claims submitted without prior authorization will be denied. Note: This policy applies only to Kentucky and South Carolina Medicaid plans and Medicare lines of business.