MedicaidPrior AuthMedium impact
Adzynma (ADAMTS13, recombinant-krhn) (Revised)
Humana·IN · Hematology, Pediatrics, Internal Medicine·Medicaid
Effective date
Feb 1, 2026
We identified it
Jul 21, 2026
Summary
This is a new Medicaid (Indiana) prior authorization policy for Adzynma (ADAMTS13, recombinant-krhn), effective February 1, 2026, with a revision date of July 22, 2026. The policy establishes coverage criteria for this enzyme replacement therapy in patients with congenital thrombotic thrombocytopenic purpura (cTTP), requiring confirmation of diagnosis, ADAMTS13 activity levels, genetic testing, and negative antibody testing. Billing teams must implement prior authorization workflows and ensure providers submit required diagnostic documentation before dispensing.
Action Required
By February 1, 2026: Billing team must establish prior authorization workflow for Adzynma (ADAMTS13, recombinant-krhn) intravenous kit. Create a checklist requiring providers to submit: (1) diagnosis of congenital (hereditary) thrombotic thrombocytopenic purpura (cTTP), (2) plasma ADAMTS13 activity level documentation showing <10 IU/dL at diagnosis, (3) molecular genetic testing confirmation of ADAMTS13 mutation, and (4) documentation of repeated negative ADAMTS13 antibody testing. Update billing system to flag all Adzynma claims for prior authorization review before processing. Train billing and provider staff on the four mandatory approval criteria. Without prior authorization approval, claims will be denied for this Indiana Medicaid line of business.