Medicare AdvantagePrior AuthMedium impact
Palforzia® (peanut allergen powder) (Revised)
Humana·Allergy & Immunology, Pediatrics, Family Medicine·Medicare Advantage
Effective date
May 27, 2026
We identified it
Jun 25, 2026
Summary
Humana updated its Palforzia (peanut allergen powder) prior authorization policy for Medicare Advantage members on May 27, 2026. The policy requires prior authorization for all Palforzia dosing levels (Initial Dose through Level 11 Maintenance) and mandates confirmation of peanut allergy diagnosis via clinical history plus positive peanut-specific IgE or skin prick test. Approval is granted for plan year duration or per clinical review.
Action Required
By May 27, 2026: Billing team must implement prior authorization requirement in billing system for all Palforzia formulations (Levels 1-11 Initial Dose, Levels 1-11 Up-Dose, and Level 11 Maintenance packets). Update claim submission workflows to require documented evidence of: (1) clinical history of allergic reaction to peanuts AND (2) positive peanut-specific IgE or positive skin prick test before submitting claims. Train front-desk and authorization staff to route all Palforzia requests to medical review. Flag prescriptions lacking required allergy testing documentation as incomplete prior authorization requests. Coordinate with providers to ensure allergy testing results are attached to all Palforzia prior authorization requests. Without proper prior authorization and supporting documentation, Humana will deny claims. Reference www.humana.com/PAL for claim coding information.