MedicaidPrior AuthLow impact
LAMZEDE® (velmanase alfa-tycv) (New)
Humana·OH · Genetics, Pediatrics, Internal Medicine +1 more·Medicaid
Effective date
Jul 1, 2026
We identified it
Jul 1, 2026
Summary
Humana Medicaid Ohio has established a new prior authorization policy for LAMZEDE® (velmanase alfa-tycv) effective July 1, 2026. This enzyme replacement therapy for non-central nervous system manifestations of alpha-mannosidosis now requires prior authorization. Billing teams must implement prior auth requirements for intravenous LAMZEDE administration to avoid claim denials.
Action Required
By June 15, 2026: Billing team must configure system to require prior authorization for all LAMZEDE (velmanase alfa-tycv) intravenous solution claims submitted to Humana Medicaid Ohio. Providers must obtain prior authorization before administering LAMZEDE to members. Update encounter forms and clinical documentation templates to include alpha-mannosidosis diagnosis verification and non-CNS manifestation confirmation. Refer to www.humana.com/PAL for applicable preauthorization and notification lists. Claims submitted without prior authorization will be denied.