MedicaidPrior AuthMedium impact
Aldurazyme® (laronidase) (New)
Humana·OH · Genetics, Pediatrics, Internal Medicine +1 more·Medicaid
Effective date
Aug 1, 2026
We identified it
Aug 1, 2026
Summary
Humana Medicaid (Ohio) has implemented a new prior authorization policy for Aldurazyme® (laronidase) effective August 1, 2026. This enzyme replacement therapy requires prior authorization for patients with Hurler or Hurler-Scheie forms of MPS I, or Scheie form with moderate to severe symptoms. Billing teams must establish prior authorization workflows before claims submission.
Action Required
By July 15, 2026: Billing team must implement prior authorization requirements for Aldurazyme (laronidase) infusions in the billing system for all Humana Medicaid Ohio members. (1) Update billing software to flag all laronidase claims for prior authorization submission before processing. (2) Providers must verify patient diagnosis is one of: Hurler form MPS I, Hurler-Scheie form MPS I, or Scheie form MPS I with moderate to severe symptoms documented in medical record before requesting authorization. (3) Direct providers to submit prior authorization requests through Humana's PAL system (www.humana.com/PAL) for medical billing coding guidance. (4) Staff should document approval duration as plan year (initial and renewal). Failure to obtain prior authorization will result in claim denial. Contact Humana for specific HCPCS codes and claim submission procedures as they are referenced on the PAL portal but not detailed in this policy document.