MedicaidPrior AuthMedium impact
Exdensur™ (depemokimab-ulaa) (New)
Humana·LA · Pulmonology, Allergy & Immunology, Pediatrics +1 more·Medicaid
Effective date
Jul 1, 2026
We identified it
Jul 1, 2026
Summary
Humana Louisiana Medicaid is implementing a new prior authorization policy for Exdensur™ (depemokimab-ulaa), a biologic treatment for severe eosinophilic asthma. This is a NEW policy effective July 1, 2026, requiring prior authorization before dispensing. Billing teams must verify three clinical criteria (severe asthma diagnosis, elevated eosinophil levels ≥150 cells/μL or ≥300 cells/μL in past 12 months, and inadequate control on maximum inhaled corticosteroids with LABA) are met before submitting claims.
Action Required
By June 15, 2026: Billing team must establish prior authorization workflow for Exdensur (depemokimab-ulaa) subcutaneous syringe in Louisiana Medicaid claims. (1) Update billing system to require prior auth submission before claim processing for this drug. (2) Create authorization request template requiring documentation of: severe asthma diagnosis, most recent eosinophil count (≥150 cells/μL at initiation OR ≥300 cells/μL in past 12 months), and current asthma regimen showing failure on maximum tolerated ICS (e.g., mometasone ≥400 mcg daily or fluticasone ≥440 mcg daily) plus LABA. (3) Notify prescribing providers and pharmacy staff that all Exdensur claims for Louisiana Medicaid must include prior authorization before dispensing. (4) Direct front desk to confirm member eligibility on Louisiana Medicaid before authorizing. Consequences: Claims submitted without prior authorization will be denied; prescriptions may not be filled.