Medicare AdvantagePrior AuthMedium impact
Gamifant® (emapalumab-lzsg) (Revised)
Humana·KY, SC · Hematology, Oncology, Critical Care·Medicaid
We identified it
Jul 1, 2026
Summary
This is a revised Prior Authorization policy for Gamifant® (emapalumab-lzsg), a rare disease immunotherapy. The policy update affects Medicare and Medicaid members in Kentucky and South Carolina. Without access to the full policy content, the specific changes from the previous version cannot be determined, but this revision requires immediate review to identify any new authorization requirements or billing guidelines.
Action Required
Immediately: Billing team must obtain and review the complete revised Gamifant® (emapalumab-lzsg) Prior Authorization policy from the source URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a56a5da). Compare the revised policy against any previous guidance to identify changes in authorization requirements, documentation needs, or billing procedures. Update any internal protocols, billing system rules, or provider communication templates accordingly. Communicate changes to all clinical and administrative staff involved in Gamifant® authorizations for Kentucky and South Carolina Medicaid and Medicare members. Failure to implement updated requirements may result in claim denials or authorization delays.