Medicare AdvantagePrior AuthMedium impact
Duvyzat (givinostat) (Revised)
Humana·Neurology, Pediatrics, Genetics·Medicare Advantage
Effective date
Sep 25, 2024
We identified it
Jul 21, 2026
Summary
Humana Medicare Advantage updated its prior authorization policy for Duvyzat (givinostat), a histone deacetylase inhibitor for Duchenne Muscular Dystrophy (DMD). The policy requires prior authorization before dispensing, with seven mandatory criteria for initial approval and two renewal criteria for continuation. Billing teams must ensure all prior auth requirements are met before claims are submitted to avoid denial.
Action Required
By September 25, 2024 (if not already implemented): Billing team must configure prior authorization requirements in billing system for Duvyzat (givinostat) oral suspension claims. Before submitting ANY Duvyzat claim, verify that ALL seven initial approval criteria are documented and satisfied: (1) confirmed DMD diagnosis via dystrophin genetic testing, (2) prescription from DMD specialist (neurologist), (3) member ambulatory status at therapy start, (4) stable baseline corticosteroid use for ≥6 months, (5) concurrent corticosteroid continuation, (6) baseline functional test documented (NSAA, 4SC, 6MWT, or 10MWT). For renewal requests, obtain provider attestation of clinical benefit with most recent functional test results. Hold all Duvyzat claims lacking complete documentation and return to providers for required information. Update encounter templates and prior auth checklists to reference these specific criteria. Failure to obtain prior authorization or missing required documentation will result in claim denials. Flag this as a specialty pharmacy medication requiring heightened review.