MedicaidPrior AuthMedium impact
Loargys® (pegzilarginase-nbln) injection solution (New)
Humana·OH · Genetics, Pediatrics, Internal Medicine +1 more·Medicaid
Effective date
Jul 1, 2026
We identified it
Jul 2, 2026
Summary
Humana Medicaid (Ohio) has established a new prior authorization policy for Loargys® (pegzilarginase-nbln) injection solution, effective July 1, 2026. Coverage requires provider attestation of Arginase 1 Deficiency diagnosis, member age ≥2 years, and concurrent protein-restricted diet. All claims for this medication must obtain prior authorization before dispensing.
Action Required
By June 15, 2026: Billing team must implement prior authorization requirement for Loargys® (pegzilarginase-nbln) injection solution in the billing system for all Ohio Medicaid members. Update claim submission workflow to require: (1) Provider attestation of ARG1-D diagnosis, (2) Verification of member age ≥2 years, and (3) Documentation of protein-restricted diet before claim submission. Notify providers and pharmacies that all Loargys claims require prior authorization through Humana's PAL system (www.humana.com/PAL). Claims submitted without prior authorization will be denied. Establish tracking for initial approvals (plan year duration) and renewal submissions (plan year duration) to prevent coverage lapses.