UnitedHealthcareMedicaid · Prior Auth · Medical Benefit Drug Policy · IN · Pulmonology, GeneticsMedium impact
Alpha1-Proteinase Inhibitors
Effective date
Dec 1, 2026
Identified
Nov 7, 2026
Summary
Effective 2026-12-01, the UnitedHealthcare Community Plan of Indiana Medicaid medical benefit drug policy for Alpha1-Proteinase Inhibitors (Aralast NP, Glassia, Prolastin-C, Zemaira) now covers these products as proven and medically necessary for chronic augmentation and maintenance therapy in patients with emphysema due to congenital alpha1-antitrypsin deficiency, with initial authorization and reauthorization each limited to no more than 12 months. The policy also removes language saying it did not apply to Indiana, adds ICD-10 code E88.01, and continues to list cystic fibrosis and conditions other than AAT-associated emphysema as unproven.
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01By 2026-12-01: Billing team should confirm that alpha1-proteinase inhibitor claims for these Indiana Community Plan Medicaid members carry diagnosis E88.01 and documentation of AAT deficiency (Pi*ZZ, Pi*Z(null), or Pi*(null)(null) phenotype, or other rare disease-causing alleles, with serum AAT <11 µmol/L), pulmonary function testing confirming emphysema, and nonsmoker status.
02Before scheduling initial therapy, providers and front desk staff should collect these records and request prior authorization for up to 12 months, and for continuation cases they should document positive clinical response (fewer exacerbations, symptom improvement, or slowed FEV1 decline) and FDA-labeled dosing before requesting reauthorization.
03Claims for these products without the required authorization and supporting documentation will be denied under the policy.
Codes mentioned
E88.01
Original notice
Alpha1-Proteinase Inhibitors
uhcprovider.com · Always check the source before changing claims.
Summaries are AI-assisted. Always confirm against the original payer notice.
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