MedicaidPrior AuthMedium impact
Exdensur™ (depemokimab-ulaa) (New)
Humana·IN · Pulmonology, Internal Medicine, Pediatrics +1 more·Medicaid
Effective date
Jul 1, 2026
We identified it
Jul 1, 2026
Summary
Humana Medicaid (Indiana) has established a new prior authorization policy for Exdensur™ (depemokimab-ulaa), an IL-5 antagonist for severe asthma with eosinophilic phenotype. Billing teams must implement prior authorization requirements before July 1, 2026, and ensure all three clinical criteria are documented before claim submission.
Action Required
By June 15, 2026: Billing and clinical teams must establish prior authorization workflow for Exdensur in the billing system for all Indiana Medicaid claims. Providers must document: (1) diagnosis of severe asthma, (2) eosinophil count ≥150 cells/μL at initiation OR ≥300 cells/μL in prior 12 months, and (3) failure of adequate control on maximum tolerated ICS+LABA therapy before submission. Update provider encounter forms and templates to capture required documentation. Claims submitted without prior authorization or missing clinical criteria will be denied. Reference Humana's PAL (Preauthorization and Notification List) at www.humana.com/PAL for applicable medical/procedural coding. Verify policy currency before each use as online version supersedes printed copies.