Medicare AdvantagePrior AuthMedium impact
Elaprase® (idursulfase) (Revised)
Humana·KY, SC · Genetics, Pediatrics, Internal Medicine·Medicaid
Effective date
Jul 22, 2026
We identified it
Jul 22, 2026
Summary
This is a revised Humana prior authorization policy for Elaprase® (idursulfase) for Hunter Syndrome treatment, effective July 22, 2026. The policy requires prior authorization and confirms that coverage applies to Medicare and Medicaid (Kentucky and South Carolina) members with a confirmed diagnosis of Hunter Syndrome (Mucopolysaccharidosis II). The single approval criterion is diagnosis verification; specific dosing (0.5 mg/kg IV weekly) and administration requirements are outlined but approval duration details are incomplete in the provided document.
Action Required
By July 22, 2026: Billing and authorization teams must implement prior authorization requirements for Elaprase (idursulfase) infusions for all Medicare and Medicaid members in Kentucky and South Carolina. Confirm all Elaprase claims for Hunter Syndrome include prior authorization before submission. Update billing software to flag Elaprase orders (HCPCS J7171) as requiring prior auth for these plan types and states. Ensure authorization documentation includes Hunter Syndrome (MPS II) diagnosis verification. Claims submitted without prior authorization will be denied. Contact Humana authorization team at www.humana.com/PAL for provider claim code requirements and preauthorization submission procedures.