Medicare AdvantagePrior AuthMedium impact
Firazyr (icatibant) (Revised)
Humana·KY · Allergy & Immunology, Pharmacy·Medicaid
Effective date
Jan 1, 2025
We identified it
Aug 11, 2026
Summary
Humana revised its Firazyr (icatibant) prior authorization policy effective January 1, 2025, with updates released January 21, 2026. The policy now applies to both Medicare and Medicaid in Kentucky and covers three HAE types with specific diagnostic and laboratory requirements. Critical change: Medicaid requests are now EXEMPT from step therapy requirements (no generic trial needed), while Medicare Part B requests retain exemptions only for continuations within 365 days.
Action Required
By February 1, 2026: Billing and prior authorization teams must immediately update intake procedures and authorization templates to reflect Medicaid step therapy exemption. For all Medicaid Firazyr/icatibant/Sajazir requests in Kentucky, REMOVE the requirement for generic icatibant trial documentation—approval criteria now only require HAE diagnosis confirmation, specialist treatment, and acute attack indication. For Medicare Part B requests, retain step therapy requirements UNLESS documentation shows continuation of prior therapy within past 365 days. Update EMR/billing system logic to flag Kentucky Medicaid claims for streamlined approval pathway. Retrain prior authorization staff on new Medicaid exemption to prevent inappropriate denials and expedite claim processing. Failure to implement will result in unnecessary prior auth delays and potential inappropriate claim denials for Medicaid beneficiaries.