Medicare AdvantagePrior AuthMedium impact
Adzynma (ADAMTS13, Recombinant-krhn) (Revised)
Humana·KY, SC · Hematology, Internal Medicine·Medicaid
We identified it
Jul 22, 2026
Summary
This is a revised Prior Authorization policy for Adzynma (ADAMTS13, Recombinant-krhn) affecting Medicare and Medicaid members in Kentucky and South Carolina. The policy establishes new or updated prior authorization requirements for this rare disease therapeutic. Billing teams must implement prior authorization procedures before submitting claims for this medication.
Action Required
Immediately: Contact Humana directly at the source URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a586826) to obtain the complete policy details, as only a summary is currently available. Billing team must: (1) Retrieve the full policy document to identify specific HCPCS drug codes and clinical criteria; (2) Update prior authorization workflows in billing system to require Humana approval before processing Adzynma claims for Kentucky and South Carolina Medicaid and Medicare members; (3) Create a provider alert and update EMR/billing documentation templates to capture required clinical information for prior authorization submission; (4) Train billing and clinical staff on submission requirements. Failure to obtain prior authorization will result in claim denials for affected members.