Medicare AdvantagePrior AuthMedium impact
Givlaari® (givosiran) (Revised)
Humana·KY, SC · Internal Medicine, Genetics, Hematology·Medicaid
We identified it
Jul 22, 2026
Summary
This is a revised Prior Authorization policy for Givlaari® (givosiran), a rare disease medication for acute intermittent porphyria. The policy update affects Medicare and Medicaid (Kentucky and South Carolina) members and establishes new or modified prior authorization requirements for this specialty pharmaceutical. Billing teams must verify the specific authorization criteria and implement updated workflows before submitting claims.
Action Required
Immediately: Obtain the complete policy document (not summary-only) from the source URL to identify specific prior authorization requirements, medical necessity criteria, and any affected billing codes. Billing team must: (1) Review full policy details once available; (2) Update billing system to flag all Givlaari® claims for prior authorization verification before submission; (3) Train staff on new authorization procedures; (4) Establish verification process with Humana Medicare and Medicaid (KY, SC) plans. Failure to obtain required prior authorization will result in claim denials. Note: Current analysis is limited by summary-only content—request complete policy documentation immediately.