Medicare AdvantagePrior AuthMedium impact
Arikayce® (liposomal amikacin for inhalation) (Revised)
Humana·Infectious Disease, Pulmonology, Pharmacy·Medicare Advantage
Effective date
Jan 1, 2020
We identified it
Jul 22, 2026
Summary
This is a revised Humana Medicare Advantage prior authorization policy for Arikayce (liposomal amikacin for inhalation) effective January 1, 2020, with the most recent revision dated July 22, 2026. The policy requires prior authorization for Arikayce use in MAC lung disease patients who have failed standard multi-drug regimens for at least 6 months and have limited treatment alternatives. Billing teams must ensure all Arikayce requests include documented evidence of prior treatment failure, negative sputum culture attempts, and multi-drug combination therapy verification before claim submission.
Action Required
Immediately: Implement prior authorization requirement for all Arikayce (liposomal amikacin for inhalation) claims submitted to Humana Medicare Advantage. Billing team must: (1) Flag all Arikayce prescriptions in billing system to require prior auth documentation before claim submission; (2) Create intake checklist requiring providers to document: diagnosis of MAC lung disease, minimum 6 consecutive months of failed multi-drug regimen therapy with sputum culture results, confirmation of limited/no alternative treatment options, and confirmation of multi-drug combination use; (3) Reject any Arikayce claims submitted as monotherapy or for non-MAC indications with denial code indicating exclusion criteria not met; (4) Route all Arikayce prior auth requests to Humana's PAL (Preauthorization and Notification List) system per policy reference at www.humana.com/PAL; (5) Staff must verify member eligibility under Humana Medicare Advantage plans only before processing. Claims submitted without prior authorization or missing required clinical documentation will be denied. Initial and renewal approvals are issued in plan year durations or per clinical review determination.