Medicare AdvantagePrior AuthMedium impact
Aldurazyme® (laronidase) (Revised)
Humana·KY, SC · Genetics, Pediatrics, Internal Medicine·Medicaid
Effective date
Jan 1, 2013
We identified it
Jun 25, 2026
Summary
Humana revised its Aldurazyme (laronidase) prior authorization policy effective January 1, 2013, with a revision date of May 27, 2026. The policy covers this enzyme replacement therapy for Mucopolysaccharidosis 1 (MPS 1) across Medicare and Medicaid (Kentucky and South Carolina) plans. Prior authorization is required for all Aldurazyme claims, and coverage is limited to patients with Hurler or Hurler-Scheie forms of MPS 1, or Scheie form with moderate to severe symptoms.
Action Required
By June 30, 2026: Billing team must verify that all Aldurazyme (laronidase) intravenous solution claims for Kentucky and South Carolina Medicaid members include prior authorization before submission. Confirm that claim scrubbing rules in billing software require documentation of MPS 1 diagnosis (Hurler, Hurler-Scheie, or Scheie form with moderate to severe symptoms) to support medical necessity. Update provider education materials to clarify that prior authorization is mandatory for this drug. Claims submitted without prior authorization will be denied. Contact Humana's PAL (Preauthorization and Notification List) system at www.humana.com/PAL for applicable claim codes and authorization procedures.