Medicare AdvantagePrior AuthMedium impact
PiaSky® (crovalimab-akkz) injection (Revised)
Humana·FL, KY, SC, VA · Hematology, Infectious Disease, Internal Medicine·Medicaid
We identified it
Jul 23, 2026
Summary
This is a new Prior Authorization policy for PiaSky® (crovalimab-akkz) injection affecting Medicare and four state Medicaid programs (Florida, Kentucky, South Carolina, Virginia). The billing team must implement prior authorization requirements before claims are submitted for this medication.
Action Required
IMMEDIATELY: Billing team must obtain the complete policy details from the source URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a584862) as only a summary is currently available. Once full policy is reviewed: (1) Update billing system to flag all PiaSky® claims for prior authorization review; (2) Identify the specific HCPCS code for crovalimab-akkz injection and configure system rules; (3) Notify providers and clinical staff that prior authorization is required before administration; (4) Add prior auth requirement to order entry systems and encounter templates. Without prior authorization, claims will be denied across Medicare Advantage, Traditional Medicare, and the four affected state Medicaid programs.