MedicaidPrior AuthMedium impact
Elaprase® (idursulfase) (New)
Humana·IN · Pediatrics, Genetics, Internal Medicine·Medicaid
Effective date
Oct 1, 2025
We identified it
Jul 21, 2026
Summary
Humana Indiana Medicaid has established a new prior authorization policy for Elaprase® (idursulfase) effective October 1, 2025, for treatment of Hunter Syndrome (Mucopolysaccharidosis II). The policy requires prior authorization and approval based on confirmed Hunter Syndrome diagnosis. Billing teams must implement prior auth requirements for all Elaprase intravenous infusions for Medicaid members in Indiana.
Action Required
By September 15, 2025: Billing team must implement prior authorization requirements in the billing system for Elaprase® (idursulfase) intravenous infusions for all Indiana Medicaid members. Configure system to flag all Elaprase claims requiring prior authorization submission to Humana before claim processing. Notify providers and infusion centers administering Elaprase that prior auth is required—claims submitted without approval will be denied. Reference Humana's Preauthorization and Notification List (PAL) at www.humana.com/PAL for specific coding and submission procedures. Ensure authorization approval is obtained before each treatment cycle and verify member eligibility for coverage of Hunter Syndrome indication prior to infusion.