Medicare AdvantagePrior AuthLow impact
Carbaglu® (carglumic acid) (Revised)
Humana·Pediatrics, Genetics, Internal Medicine·Medicare Advantage
Effective date
Nov 26, 2025
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its prior authorization policy for Carbaglu (carglumic acid) effective November 26, 2025. The policy covers this rare disease medication for three indications: acute or chronic hyperammonemia due to NAGS deficiency, and acute hyperammonemia due to propionic acidemia (PA) or methylmalonic acidemia (MMA). Prior authorization is required for all covered uses, with approval granted for the plan year duration initially and renewable annually.
Action Required
Before November 26, 2025: Billing team must implement prior authorization requirements for Carbaglu (carglumic acid) 200mg dispersible tablets in the billing system. Update authorization protocols to require submission of documentation confirming one of the three covered diagnoses (NAGS deficiency, PA, or MMA) before claims processing. This affects only Medicare Advantage members with rare metabolic disorders. Route all Carbaglu requests through prior authorization workflow; claims submitted without prior auth approval will be denied.