MedicaidPrior AuthMedium impact
Adzynma (ADAMTS13, recombinant-krhn) (Revised)
Humana·OH · Hematology, Pediatrics, Internal Medicine·Medicaid
Effective date
Feb 1, 2026
We identified it
Jul 21, 2026
Summary
This is a new Medicaid (Ohio) prior authorization policy for Adzynma (ADAMTS13, recombinant-krhn), effective February 1, 2026, with a revision dated July 22, 2026. The policy establishes coverage criteria for this enzyme replacement therapy in adult and pediatric patients with congenital thrombotic thrombocytopenic purpura (cTTP), requiring prior authorization and confirmation of diagnosis through plasma ADAMTS13 activity testing, molecular genetic testing, and antibody screening before approval.
Action Required
By February 1, 2026: Billing team must establish prior authorization workflow for Adzynma intravenous kit claims submitted by Ohio Medicaid members. Clinical staff must verify all four coverage criteria are met before claim submission: (1) cTTP diagnosis documented, (2) plasma ADAMTS13 activity <10 IU/dL at diagnosis, (3) ADAMTS13 mutation confirmed by molecular genetic testing, and (4) repeated negative ADAMTS13 antibody testing completed. Update billing system to flag Adzynma claims for mandatory prior auth review. Providers should include all diagnostic test results and genetic confirmation with authorization requests. Claims submitted without prior authorization or missing required documentation will be denied. Reference the Humana PAL portal (www.humana.com/PAL) for applicable medical billing codes and preauthorization procedures.