MedicaidPrior AuthMedium impact
Korsuva™ (difelikefalin) (New)
Humana·IN · Nephrology, Pharmacy·Medicaid
Effective date
Aug 1, 2026
We identified it
Aug 4, 2026
Summary
Humana Indiana Medicaid has established a new prior authorization policy for Korsuva (difelikefalin), an IV medication for treating chronic kidney disease-associated pruritus in hemodialysis patients. The policy requires prior authorization for initial approval (6 months) and renewal requests, with specific clinical criteria that must be met. Billing teams must implement prior auth requirements immediately for this new drug coverage effective August 1, 2026.
Action Required
By July 15, 2026: Billing team must configure prior authorization requirement in billing system for Korsuva (difelikefalin) 65mcg/1.3ml IV solution for Humana Indiana Medicaid members. Before submitting claims: Verify member meets BOTH initial approval criteria—(1) diagnosis of CKD-aP/uremic pruritus, AND (2) consistent hemodialysis 3+ times per week for previous 3 months. For renewal requests after 6 months: Verify member continues hemodialysis 3+ times per week AND has documented efficacy showing decreased pruritus. Submit prior authorization requests through www.humana.com/PAL using applicable preauthorization codes before dispensing. Update billing system to enforce these requirements or claims will be denied. Front-desk staff should flag Korsuva claims for prior auth verification before patient communication.