MedicaidPrior AuthMedium impact
Loargys® (pegzilarginase-nbln) injection solution (New)
Humana·LA · Pharmacy, Pediatrics, Genetics +1 more·Medicaid
Effective date
Jul 1, 2026
We identified it
Jul 2, 2026
Summary
Humana Medicaid (Louisiana) has established a new prior authorization policy for Loargys® (pegzilarginase-nbln) injection solution effective July 1, 2026, for treating Arginase 1 Deficiency in patients 2 years and older. Prior authorization requires provider attestation of ARG1-D diagnosis, confirmation of patient age ≥2 years, and documentation that the member will use the drug with a protein-restricted diet. All claims for this medication must obtain prior authorization before dispensing to avoid denial.
Action Required
By July 1, 2026: Billing team and pharmacy staff must implement prior authorization workflow for Loargys® (pegzilarginase-nbln) injection solution for all Louisiana Medicaid members. (1) Update billing system/pharmacy software to flag all Loargys® prescriptions as requiring prior authorization. (2) Create or update prior authorization request form to capture three required criteria: (a) provider attestation of ARG1-D diagnosis, (b) member age verification (≥2 years), (c) documentation of concurrent protein-restricted diet use. (3) Train pharmacy staff and billing staff on submission requirements to Humana's PAL system (www.humana.com/PAL). (4) Establish internal checklist to verify all three approval criteria are met before authorizing dispensing. Claims submitted without prior authorization or missing required documentation will be denied. Route all prior authorization requests through Humana's medical review process; approval duration follows initial and renewal plan year timelines per policy.