Medicare AdvantagePrior AuthMedium impact
Nexviazyme™ (avalglucosidase alfa-ngpt) Injection (Revised)
Humana·KY, SC · Genetics, Neurology, Internal Medicine +2 more·Medicaid
Effective date
May 27, 2026
We identified it
Jun 25, 2026
Summary
Humana revised its prior authorization policy for Nexviazyme™ (avalglucosidase alfa-ngpt) effective May 27, 2026, for Medicare and Medicaid (Kentucky and South Carolina). The policy maintains two approval criteria: confirmed late-onset Pompe disease diagnosis and supporting lab/genetic testing (GAA enzyme deficiency or pathogenic GAA gene variants). This is a routine policy revision with no substantive coverage changes but requires verification of current authorization requirements.
Action Required
By May 27, 2026: Billing and prior authorization teams must verify this is the current Nexviazyme policy version in their authorization system. For any pending or new Nexviazyme prior authorization requests: (1) Ensure patient has confirmed late-onset Pompe disease diagnosis in medical record; (2) Verify supporting documentation includes lab work or genetic testing showing GAA enzyme deficiency or pathogenic GAA gene variants; (3) Route requests through standard prior authorization workflow for applicable plans (Medicare, Medicaid-Kentucky, Medicaid-South Carolina). Update internal policy files to reflect May 27, 2026 revision date. Claims without proper prior authorization will be denied. Note: Policy document does not specify approval duration periods (appears incomplete on page 1)—contact Humana PAL or medical director to confirm initial and renewal authorization lengths before implementation.