Traditional MedicarePrior AuthMedium impact
Exdensur™ (depemokimab-ulaa) (Revised)
Humana·KY, SC · Pulmonology, Internal Medicine, Pediatrics·Medicaid
Effective date
Jul 1, 2026
We identified it
Jul 1, 2026
Summary
Humana revised its prior authorization policy for Exdensur™ (depemokimab-ulaa) effective July 1, 2026, covering Medicare Part D, Medicare Part B, and Medicaid (Kentucky and South Carolina). For Medicaid requests, the policy requires members to have severe asthma with eosinophilic phenotype (≥150 cells/μL at initiation or ≥300 cells/μL in prior 12 months) and failed adequate control on maximum tolerated inhaled corticosteroid plus long-acting beta agonist therapy. Prior authorization is mandatory before dispensing.
Action Required
By July 1, 2026: Billing and prior authorization teams must implement the revised Exdensur™ prior authorization requirements in the billing system. (1) Configure system to require prior authorization for all Exdensur claims for Medicare Part D, Medicare Part B, and Medicaid (KY, SC) members. (2) Update prior auth submission templates to require documentation of: severe asthma diagnosis, peripheral blood eosinophil count (≥150 cells/μL at therapy initiation OR ≥300 cells/μL in previous 12 months), and evidence of maximum tolerated inhaled corticosteroid therapy (e.g., mometasone ≥400 mcg daily or fluticasone ≥440 mcg daily) combined with long-acting beta agonist (e.g., formoterol). (3) For Medicare Part B requests, ensure step therapy exception is documented if continuation of prior therapy within past 365 days. (4) For Medicaid requests, verify member attempted or cannot use Nucala AND Fasenra (no step therapy exception for Medicaid). (5) Communicate revised criteria to all providers submitting Exdensur requests. (6) Train front-desk and billing staff on new documentation requirements. Claims submitted without prior authorization or missing required clinical documentation will be denied.