Medicare AdvantagePrior AuthMedium impact
Andembry ® (garadacimab-gxii) (Revised)
Humana·SC · Hematology, Infectious Disease·Medicaid
We identified it
Jul 21, 2026
Summary
This is a revised Prior Authorization policy for Andembry® (garadacimab-gxii), a new therapeutic agent. The policy establishes prior authorization requirements for Medicare and Medicaid members in South Carolina. Billing teams must implement prior auth procedures before dispensing or billing for this medication.
Action Required
Immediately: Billing and clinical teams must obtain prior authorization from Humana before administering or billing Andembry® (garadacimab-gxii) to South Carolina Medicare and Medicaid members. Update billing system to flag Andembry® prescriptions/administrations as requiring prior auth. Add medication to prior auth checklist in EMR. Route all requests through the Humana prior auth portal at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a58480c. Claims submitted without documented prior authorization approval will be denied.