Medicare AdvantagePrior AuthLow impact
Givlaari® (givosiran) (Revised)
Humana·KY, SC · Internal Medicine, Gastroenterology, Genetics·Medicaid
Effective date
Aug 27, 2025
We identified it
Jun 25, 2026
Summary
Humana revised its Givlaari (givosiran) prior authorization policy effective August 27, 2025, for Medicare and Medicaid (Kentucky and South Carolina). The policy maintains three prior authorization criteria: confirmed acute hepatic porphyria diagnosis with elevated PBG/ALA or genetic confirmation, documented symptoms consistent with acute hepatic porphyria, and administration by a healthcare professional. This is a routine policy revision with no substantive coverage changes identified.
Action Required
By August 27, 2025: Billing and prior authorization teams must verify current policy version in Humana's online system (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a515b03) and do NOT use printed copies. No workflow changes are required unless your practice was using an outdated version of this policy. Confirm that PA requests for Givlaari submissions include all three required criteria: (1) confirmed AHP diagnosis with PBG/ALA levels or genetic testing results, (2) documented symptoms from acute attacks, and (3) confirmation that a healthcare professional will administer the injection. Update internal documentation if referencing this policy to cite the August 27, 2025 revision date to ensure compliance with Humana's current guidance.