Medicare AdvantagePrior AuthMedium impact
Arikayce® (liposomal amikacin for inhalation) (Revised)
Humana·Infectious Disease, Pulmonology, Internal Medicine·Medicare Advantage
Effective date
Feb 25, 2026
We identified it
Jun 25, 2026
Summary
Humana's Medicare Advantage plan has revised its prior authorization policy for Arikayce (liposomal amikacin for inhalation), effective February 25, 2026. The policy maintains strict coverage criteria requiring MAC lung disease diagnosis, failure of 6+ months of multi-drug therapy with negative sputum cultures, limited alternative options, and use as part of a multi-drug regimen. Arikayce cannot be used as monotherapy, for non-MAC infections, or continued beyond 6 months if sputum cultures do not convert to negative.
Action Required
By February 25, 2026: Billing team must ensure all Arikayce claims submissions include prior authorization approval. Prior to submission, verify in the billing system that: (1) member has documented MAC lung disease diagnosis, (2) member failed minimum 6 consecutive months of multi-drug regimen with documented negative sputum culture failure, (3) documentation confirms limited/no alternative treatment options, and (4) prescriber confirms Arikayce will be used in combination therapy (not monotherapy). Do NOT process claims for Arikayce monotherapy, non-MAC infections, or non-refractory MAC conditions. Do NOT process renewal claims for members who failed to achieve negative sputum cultures after 6 months of Arikayce therapy. Route all requests through Humana's PAL (Preauthorization and Notification List) at www.humana.com/PAL. Claims submitted without prior authorization will be denied.