MedicaidPrior AuthMedium impact
Thrombate III® [Antithrombin III (Human)] (Revised)
Humana·IN · Hematology, Critical Care, OB-GYN +1 more·Medicaid
Effective date
Aug 27, 2025
We identified it
Sep 2, 2026
Summary
Humana Indiana Medicaid has issued a revised prior authorization policy for Thrombate III (Antithrombin III Human), effective August 27, 2025. Coverage requires documented hereditary antithrombin deficiency and use for treatment or prevention of thromboembolism, including peri-operative or peri-partum prophylaxis. This is a new policy establishment for this specific drug with defined authorization criteria.
Action Required
By August 27, 2025: Billing and prior authorization teams must implement the Thrombate III prior authorization requirement for Indiana Medicaid members. (1) Update billing system to flag all Thrombate III (antithrombin III human) claims for mandatory prior authorization. (2) Create or update prior authorization request templates requiring: confirmed diagnosis of hereditary antithrombin deficiency AND documented clinical use (treatment of thromboembolism, prevention of peri-operative thromboembolism, or prevention of peri-partum thromboembolism). (3) Train authorization reviewers on the two-criterion approval pathway per policy. (4) Communicate requirement to providers administering this drug (typically hematology, anticoagulation clinics, and operating room staff). (5) Verify claim submission processes route to PAL (Preauthorization and Notification List) via www.humana.com/PAL for correct coding. Failure to obtain prior authorization will result in claim denials for Indiana Medicaid members.