MedicaidPrior AuthLow impact
Givlaari® (givosiran) (Revised)
Humana·KY, SC · Internal Medicine, Hematology, Genetics·Medicaid
Effective date
Mar 18, 2020
We identified it
Jul 22, 2026
Summary
This is a revised Humana prior authorization policy for Givlaari® (givosiran) for treating acute hepatic porphyria, effective March 18, 2020 with the most recent revision dated July 22, 2026. The policy requires prior authorization and confirms three clinical criteria: confirmed diagnosis via elevated PBG/ALA or genetic testing, documented symptoms consistent with acute hepatic porphyria, and administration by a healthcare professional. No substantive coverage changes are evident in this revision compared to the original effective date.
Action Required
By July 22, 2026: Billing and clinical teams should verify this is the current policy version on Humana's website and ensure all Givlaari® requests for Medicaid members in Kentucky and South Carolina include prior authorization. No immediate workflow changes are required unless your practice was not previously compliant with these three clinical criteria. Confirm that all prior auth submissions document: (1) confirmed acute hepatic porphyria diagnosis with PBG/ALA elevations or genetic confirmation, (2) documented symptoms from prior attacks or chronic manifestations, and (3) that a healthcare professional will administer the drug. Update your prior auth checklist if these criteria were not previously enforced. Reference the full policy at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a5867e8 before submitting requests.