Medicare AdvantagePrior AuthLow impact
Cerdelga® (eliglustat) (Revised)
Humana·Pharmacy, Genetics, Internal Medicine·Medicare Advantage
Effective date
Jun 26, 2024
We identified it
Jun 25, 2026
Summary
Humana updated its Cerdelga (eliglustat) prior authorization policy on June 26, 2024, for Medicare Advantage and Commercial plans. The policy requires prior authorization for Cerdelga in adult patients with Type 1 Gaucher disease who have documented CYP2D6 metabolizer status (PM, EM, or IM) confirmed by FDA-approved genetic testing. No billing codes are specified in this pharmacy policy; requests must be submitted through Humana's PAL system.
Action Required
By July 31, 2024: Billing and pharmacy teams must be aware that all Cerdelga requests for Medicare Advantage and Commercial plans require prior authorization submission through Humana's PAL system (www.humana.com/PAL). Ensure prescribers have CYP2D6 genetic test results documented before submitting prior auth requests. Pharmacy staff should direct patients to the Genzyme Patient Assistance Program (cerdelga.com or 1-800-745-4447, option #3) for genetic testing cost assistance. Clinical staff should screen for contraindications: cardiac disease, long QT syndrome, and concomitant use of Class IA/III antiarrhythmics. Failure to obtain prior authorization will result in claim denials.