High impact
Soliris® (eculizumab) and biosimilars (New)
Humana·Effective Aug 1, 2026
Humana Medicaid (Ohio) has implemented a new prior authorization policy effective August 1, 2026, for Soliris® (eculizumab) and biosimilars (Bkemv, Epysqli) covering four rare conditions: PNH, aHUS, gMG, and NMOSD. The policy establishes specific clinical criteria for approval, including diagnostic confirmations, antibody testing, specialist supervision, and prior treatment requirements depending on indication. Billing teams must implement prior authorization workflows immediately to avoid claim denials for these high-cost specialty medications.