Medicare AdvantagePrior AuthLow impact
Elelyso® (taliglucerase alfa) (Revised)
Humana·KY, SC · Hematology, Internal Medicine, Pediatrics·Medicaid
Effective date
Mar 25, 2026
We identified it
Jun 25, 2026
Summary
Humana revised its Elelyso® (taliglucerase alfa) prior authorization policy effective March 25, 2026. The policy maintains coverage for Type 1 Gaucher disease treatment in Medicare and Medicaid (Kentucky and South Carolina) members, requiring confirmed diagnosis as the primary approval criterion. This is a routine policy revision with no substantive coverage changes from the previous version.
Action Required
By March 25, 2026: Billing and prior authorization staff should verify this is the current policy version by referencing Humana's online policy portal at www.humana.com/PAL before processing any Elelyso claims. No workflow changes are required—continue existing prior authorization procedures for Elelyso requests that document confirmed Type 1 Gaucher disease diagnosis. Ensure claims are submitted only for Medicare Advantage, Traditional Medicare, and applicable Medicaid (Kentucky and South Carolina) plans. Failure to use the current policy version may delay authorization, but substantive coverage criteria remain unchanged.