MedicaidAdministrativeLow impact
Lumizyme® (alglucosidase alpha) (Revised)
Humana·KY, SC · Pediatrics, Neurology, Genetics·Medicaid
Effective date
Jan 1, 2011
We identified it
Jun 25, 2026
Summary
This is a routine policy revision for Lumizyme (alglucosidase alpha) coverage under Humana's Medicaid plans in Kentucky and South Carolina, effective January 1, 2011, with the most recent update dated August 27, 2025. The policy maintains prior authorization requirements for this orphan drug used to treat Pompe disease, with approvals granted for plan year durations or through clinical review. No substantive coverage changes are documented in this revision; this appears to be a standard periodic policy refresh with updated prescribing information references.
Action Required
No immediate action required. This is a maintenance revision of an existing policy with no changes to coverage criteria, prior authorization requirements, or billing workflows. Billing teams in Kentucky and South Carolina should verify this is the current version in Humana's system before processing any Lumizyme claims. Continue following established prior authorization procedures: confirm member has Pompe disease diagnosis before submitting claims. No workflow changes needed at this time.