Medicare AdvantagePrior AuthMedium impact
Enspryng® (satralizumab-mwge) (Revised)
Humana·SC · Neurology, Pharmacy·Medicaid
Effective date
May 27, 2026
We identified it
Jun 25, 2026
Summary
Humana revised its prior authorization policy for Enspryng® (satralizumab-mwge) for Neuromyelitis Optica Spectrum Disorder (NMOSD) effective May 27, 2026. The policy requires two mandatory criteria for approval: anti-aquaporin-4 (AQP4) antibody positivity and at least one core clinical characteristic of NMOSD. This applies to Medicare and Medicaid members in South Carolina and requires prior authorization before dispensing.
Action Required
By May 27, 2026: Billing team must implement prior authorization requirements for Enspryng® (satralizumab-mwge) in billing software for all South Carolina Medicare and Medicaid members. Update pharmacy system workflows to verify: (1) Anti-AQP4 antibody positive status documented before approval, and (2) At least one documented core clinical characteristic (optic neuritis, acute myelitis, area postrema syndrome, acute brainstem syndrome, symptomatic narcolepsy, or symptomatic cerebral syndrome). Providers must submit prior auth requests with supporting documentation confirming both criteria. Train pharmacy staff to flag claims missing these required elements. Claims processed without proper prior authorization will be denied. Reference Humana's Preauthorization and Notification List (PAL) at www.humana.com/PAL for applicable coding information.