MedicaidPrior AuthMedium impact
Vyvgart® Hytrulo (efgartigimod alfa and hyaluronidase-qvfc) (New)
Humana·IN · Neurology·Medicaid
Effective date
Aug 1, 2026
We identified it
Aug 13, 2026
Summary
Humana Medicaid (Indiana) has established a new prior authorization policy for Vyvgart® Hytrulo (efgartigimod alfa and hyaluronidase-qvfc) effective August 1, 2026. Coverage requires prior authorization for two indications: generalized myasthenia gravis (gMG) in anti-AChR antibody-positive patients and chronic inflammatory demyelinating polyneuropathy (CIDP), both requiring specialist supervision. Billing teams must implement prior authorization requirements before claims submission to avoid denials.
Action Required
By July 15, 2026: Billing team must implement prior authorization requirement in billing system for Vyvgart Hytrulo (efgartigimod alfa and hyaluronidase-qvfc) subcutaneous solution and syringe formulations. Before submitting any Vyvgart Hytrulo claims for Indiana Medicaid members, verify: (1) member has documented diagnosis of gMG with confirmed anti-AChR antibodies OR CIDP; (2) prescribing provider is a neurologist or specialist experienced in managing the condition; (3) prior authorization has been obtained from Humana. Update claim submission workflows to require prior auth submission to Humana before dispensing. Notify all prescribers and pharmacy staff that claims will be denied without prior authorization. Reference Humana's Preauthorization and Notification List (PAL) at www.humana.com/PAL for specific coding requirements.