Why did Humana add collagenase enzyme (Xiaflex) injection for Dupuytren’s Contracture to the 2022 authorization list?
- A greater focus on managing collagenase enzyme injection (Xiaflex) for Dupuytren’s Contracture in 2022 was prioritized in response to an observed trend indicating:
- Unexplainable variability in treatment patterns across providers
- Opportunities to drive providers to choose the most clinically appropriate, indication optimal treatment option for patients (pharmacologic or surgical).
What criteria will Cohere use to review medical necessity and clinical appropriateness?
- Cohere will leverage Humana’s Medicare and Commercial Policies to review medical necessity and clinical appropriateness before making any coverage determinations.
What is the turnaround time for a decision?
- Requests meeting Cohere’s clinical guidelines may receive immediate auto-approval (in most cases). That is, an approval decision in seconds. Requests not meeting clinical guidelines may pend for manual review by Cohere’s clinical operations team of nurses and physicians.
- This means that a “same-day-of-appointment decision” may be possible if the request is auto- approved, but this is not guaranteed and should not be expected.
Where can I review Humana’s authorization list in more detail?
- The preauthorization list can be reviewed on Humana’s website at www.humana.com/pal.
Which indications require authorization?
- All medically accepted indications other than treatment for Peyronie’s disease require submission of a preauthorization for the use of Xiaflex.
Are providers required to submit a authorization for the use of Xiaflex to treat Peyronie's disease?
- Providers will not be required to submit a authorization for the use of Xiaflex to treat Peyronie’s disease.