Medicare AdvantagePrior AuthMedium impact
Rezzayo Intravenous Solution (Revised)
Humana·Infectious Disease, Critical Care, Internal Medicine·Medicare Advantage
Effective date
Aug 23, 2023
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has updated its prior authorization policy for Rezzayo (rezafungin) intravenous solution, effective August 23, 2023, with the most recent revision dated March 25, 2026. The policy requires prior authorization for candidemia and invasive candidiasis treatment, with approval limited to patients who have failed, have contraindications to, or are intolerant of caspofungin or micafungin. Both initial and renewal approvals are limited to 6-month periods.
Action Required
By April 1, 2026 (implementation deadline): Billing team must establish prior authorization workflow for Rezzayo intravenous solution claims under Medicare Advantage plans. (1) Update billing system to flag all Rezzayo claims for mandatory prior authorization review before claim submission. (2) Create or update clinical criteria checklist in EMR/billing system requiring documentation of: (a) confirmed diagnosis of candidemia OR invasive candidiasis, AND (b) evidence of prior therapy with, contraindication to, or intolerance of caspofungin or micafungin. (3) Establish internal process to submit prior authorization requests to Humana before administering Rezzayo, noting that approval duration is 6 months initially and 6 months for renewal. (4) Brief clinical staff and providers on new requirements, emphasizing that claims submitted without documented prior authorization will be denied. (5) Refer to www.humana.com/PAL for current provider claim codes and preauthorization requirements. Failure to obtain prior authorization will result in claim denials.