Medicare AdvantagePrior AuthLow impact
Fabrazyme® (agalsidase beta) and Elfabrio® (pegunigalsidase alfa) (Revised)
Humana·KY, SC · Genetics, Nephrology, Cardiology +1 more·Medicaid
Effective date
Jan 1, 2012
We identified it
Jun 25, 2026
Summary
Humana revised its prior authorization policy for Fabrazyme (agalsidase beta) and Elfabrio (pegunigalsidase alfa) on December 17, 2025, affecting Medicare and Medicaid (Kentucky and South Carolina) members. The policy maintains the single approval criterion: documented diagnosis of Fabry disease. No significant coverage changes were identified; this appears to be a routine policy refresh with updated effective dates.
Action Required
No immediate action required. This is a routine policy revision affecting a rare disease treatment (Fabry disease enzyme replacement therapy). Verify your current billing system reflects the prior authorization requirement for Fabrazyme and Elfabrio claims for Kentucky and South Carolina Medicaid and Medicare members. Confirm that prior authorization requests include documented Fabry disease diagnosis. If your practice does not currently treat Fabry disease patients, no workflow changes are needed.