Medicare AdvantagePrior AuthMedium impact
Galafold®(migalastat) (Revised)
Humana·Genetics, Nephrology, Cardiology +1 more·Medicare Advantage
Effective date
Dec 17, 2025
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage updated its Galafold (migalastat) pharmacy coverage policy effective December 17, 2025. The policy maintains prior authorization requirements for Fabry disease treatment but clarifies that patients must have a confirmed diagnosis AND a GLA variant amenable to migalastat therapy as validated by GLP HEK assay. This is a revision to the original September 26, 2018 policy with no substantive coverage changes, but billing teams must ensure prior authorization requests include GLP HEK assay confirmation before claim submission.
Action Required
By December 17, 2025: Billing and prior authorization team must update internal documentation and workflows to ensure all Galafold (migalastat) prior authorization requests for Medicare Advantage members include verification that the patient has: (1) confirmed Fabry disease diagnosis AND (2) GLA variant amenability confirmed by GLP HEK assay. Do not process claims without both criteria documented. Update prior authorization templates and submission checklists to require GLP HEK assay documentation from providers. Train clinical reviewers to verify GLA variant amenability before approving Galafold requests. Reference the updated policy at www.humana.com/PAL before submitting any authorization requests. Claims submitted without GLP HEK assay documentation will be denied or delayed pending additional information.