MedicaidPrior AuthMedium impact
Rystiggo (rozanolixizumab-noli) (New)
Humana·OH · Neurology·Medicaid
Effective date
Aug 1, 2026
We identified it
Aug 4, 2026
Summary
Humana Medicaid (Ohio) has established a new prior authorization policy for Rystiggo (rozanolixizumab-noli), effective August 1, 2026. This monoclonal antibody is approved for generalized myasthenia gravis (gMG) in anti-AChR or anti-MuSK antibody-positive patients who have failed or are intolerant to pyridostigmine and at least one immunosuppressive therapy. Prior authorization is required before dispensing, with approval valid for the plan year.
Action Required
By July 15, 2026: Billing and prior authorization teams must implement this new Medicaid Ohio policy into the PA request workflow. (1) Create a new PA submission requirement in the billing system for Rystiggo (NDC to be confirmed with pharmacy benefit manager). (2) Establish a clinical review checklist verifying: gMG diagnosis confirmation, antibody testing results (anti-AChR or anti-MuSK documented), treating neurologist oversight, and prior treatment history with pyridostigmine AND at least one immunosuppressant (azathioprine, cyclosporine, mycophenolate mofetil, tacrolimus, methotrexate, cyclophosphamide, or cyclosporine). (3) Update provider communication templates and encounter forms to prompt documentation of failed prior therapies and specialist involvement. (4) Train billing and front-desk staff that claims submitted without prior authorization approval will be denied. (5) Verify patient eligibility is limited to Medicaid (Ohio) only; do not apply to other states or plan types. (6) Note that this is a subcutaneous injectable administered by healthcare professional (not patient self-administered), so confirm proper facility billing codes with medical billing if applicable. For medically billed administration requests, reference www.humana.com/PAL for claim code guidance.