Medicare AdvantagePrior AuthMedium impact
Obizur [antihemophilic (recombinant), porcine sequence] (Revised)
Humana·KY · Hematology, Internal Medicine·Medicaid
Effective date
Apr 22, 2026
We identified it
Jun 25, 2026
Summary
Humana revised its Obizur (antihemophilic factor recombinant, porcine sequence) pharmacy coverage policy for Kentucky Medicare and Medicaid members. This is a FRESH POLICY UPDATE (1 day old) requiring prior authorization for on-demand treatment of acquired hemophilia A bleeding episodes. The policy clarifies eligibility criteria, dosing requirements, and contraindications, with critical emphasis on confirming acquired hemophilia A diagnosis and active bleeding status before authorization.
Action Required
By April 22, 2026: Billing team must implement prior authorization requirements for all Obizur claims in Kentucky for Medicare and Medicaid members. Update billing system rules to: (1) Require PA submission before claims processing; (2) Verify member meets BOTH approval criteria—diagnosis of acquired hemophilia A (autoantibodies to factor VIII) AND active bleeding episode; (3) Screen for exclusion (congenital hemophilia A treatment); (4) Document baseline anti-porcine factor VIII inhibitor titer if available. Before claim submission, providers must confirm initial dosing at 200 units/kg and document clinical justification. Flag any requests for congenital hemophilia A treatment as non-approvable. Train billing and PA staff that this applies only to Kentucky Medicaid and Medicare members. Failure to obtain PA will result in claim denials. Contact Humana's PAL system at www.humana.com/PAL for specific medical/procedural coding requirements for this medication.