Medicare AdvantagePrior AuthMedium impact
Voxzogo™ (vosoritide) (Revised)
Humana·Endocrinology, Pediatrics, Genetics·Medicare Advantage
Effective date
Feb 23, 2022
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage updated its Voxzogo (vosoritide) prior authorization policy on June 24, 2026. The policy requires prior authorization for this CNP analog injection used to treat pediatric achondroplasia, with three specific approval criteria: genetically confirmed diagnosis, open epiphyses confirmed by imaging, and specialist prescribing/consultation. Approval is granted in plan year durations or through clinical review.
Action Required
By June 24, 2026 (current): Billing team must implement prior authorization requirements for all Voxzogo (vosoritide) claims submitted to Humana Medicare Advantage plans. Before submitting claims, verify that: (1) patient has genetically confirmed achondroplasia diagnosis documented in medical record, (2) imaging confirms open epiphyses, and (3) prescription originates from or includes consultation with an achondroplasia specialist (endocrinologist or similar). Update claim submission workflows to flag Voxzogo for mandatory prior authorization. Contact Humana preauthorization department at www.humana.com/PAL for medically billed request procedures and applicable coding information. Train clinical and billing staff on the three approval criteria. All claims submitted without meeting these criteria or without prior authorization will be denied. Note: This is an accelerated approval medication—continued coverage may depend on confirmatory trial results.