Medicare AdvantagePrior AuthMedium impact
Firazyr (icatibant) (Revised)
Humana·KY · Allergy & Immunology, Internal Medicine·Medicaid
Effective date
Jan 1, 2025
We identified it
Jul 23, 2026
Summary
Humana's revised Firazyr (icatibant) policy for Kentucky Medicaid and Medicare clarifies prior authorization requirements for HAE treatment, distinguishing between HAE Type 1/2 (with C1-INH deficiency) and HAE Type 3 (with normal C1-INH). Key change: For Medicaid requests, step therapy requirements do not apply, meaning prior generic icatibant trial is NOT required for brand Firazyr approval.
Action Required
By January 21, 2026 (revision date): Prior Authorization team must update criteria in billing/PA system to reflect that Medicaid members requesting brand Firazyr do NOT require documentation of prior generic icatibant trial or intolerance—step therapy is waived for Medicaid. For Medicare Part B requests, maintain step therapy requirement unless continuation of prior therapy within 365 days. Update PA submission templates and reviewer guidance to distinguish between HAE Type 1/2 (requiring C1-INH levels/mutation) and HAE Type 3 (requiring normal C1-INH levels plus family history or genetic mutation). All HAE-related Firazyr requests must now include C1q lab values per policy criteria. Notify providers and billing staff that this revision removes a documentation barrier for Medicaid patients. Failure to apply correct step therapy rules will result in inappropriate denials or unnecessary delays.