Medicare AdvantagePrior AuthMedium impact
Skyclarys™ (omaveloxolone) (Revised)
Humana·Neurology, Genetics·Medicare Advantage
Effective date
Mar 25, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage updated its Skyclarys (omaveloxolone) prior authorization policy for Friedreich's ataxia treatment, effective March 25, 2026. The policy requires prior authorization with six specific approval criteria including genetic testing confirmation, specialist prescribing, and baseline laboratory tests (liver function, BNP, lipid panel) with mandatory monthly monitoring for the first three months.
Action Required
By March 25, 2026: Billing and prior authorization teams must update systems to require prior authorization for Skyclarys (omaveloxolone) prescriptions for Medicare Advantage members. Before approval, verify all six criteria are met: (1) Friedreich's ataxia diagnosis; (2) GAA triplet-repeat expansion confirmed via genetic testing; (3) prescription by neurologist or specialist experienced with FRDA; (4) baseline liver function tests (ALT, AST, bilirubin) with provider agreement for monthly repeats for first 3 months; (5) baseline BNP and lipid panel obtained; (6) supporting documentation submitted. Create/update encounter forms and prior auth checklists to capture all required documentation. Notify providers that claims without completed prior authorization meeting all six criteria will be denied. Flag prescriptions from non-specialist providers for additional review.