MedicaidPrior AuthMedium impact
Gamifant® (emapalumab-lzsg) (Revised)
Humana·IN · Hematology, Oncology, Pediatrics +1 more·Medicaid
We identified it
Jul 1, 2026
Summary
Humana has issued a revised prior authorization policy for Gamifant® (emapalumab-lzsg), a specialty immunotherapy drug for Medicaid-Indiana members. This policy update requires billing teams to verify prior authorization requirements before claims submission to avoid denials.
Action Required
Immediately: Billing team must implement prior authorization verification for Gamifant® (J9210) claims submitted for Medicaid-Indiana members. Before submitting any claims for this drug: (1) Contact Humana Medicaid-Indiana prior authorization department using the URL https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a56a5d6 to obtain current requirements and authorization procedures; (2) Update billing system to flag all J9210 claims requiring prior auth documentation; (3) Train providers and clinical staff on medical necessity documentation requirements. Claims submitted without prior authorization will be denied and require resubmission, delaying reimbursement.