Medicare AdvantageAdministrativeLow impact
Elaprase® (idursulfase) (Revised)
Humana·KY, SC · Genetics, Pediatrics, Internal Medicine·Medicaid
Effective date
Aug 27, 2025
We identified it
Jun 25, 2026
Summary
This is a routine revision of Humana's Elaprase (idursulfase) prior authorization policy for Hunter Syndrome treatment, effective for Medicare, Kentucky Medicaid, and South Carolina Medicaid. The policy maintains the existing single approval criterion (confirmed Hunter Syndrome diagnosis) and approval duration structure (plan year or clinical review). No substantive coverage changes are indicated; this appears to be a standard policy maintenance update.
Action Required
By September 30, 2025: Billing and prior authorization teams should verify current policy language in the Humana system matches this August 27, 2025 revision. No immediate workflow changes are required unless your practice treats Hunter Syndrome patients receiving Elaprase infusions. If applicable, confirm that prior authorization requests for Elaprase include documented Hunter Syndrome (MPS II) diagnosis confirmation. Update any internal policy documentation or checklists to reference revision date 8/27/2025 to ensure staff reference the current version rather than outdated materials.