MedicaidPrior AuthMedium impact
Elahere (mirvetuximab soravtansine-gynx) (New)
Humana·OH · Oncology, OB-GYN·Medicaid
Effective date
Jun 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has established a new prior authorization policy for Elahere (mirvetuximab soravtansine-gynx), an IV cancer treatment for platinum-resistant ovarian, fallopian tube, or primary peritoneal cancers. The policy requires specific clinical criteria including high folate receptor alpha expression and limits use to patients who have received 1-3 prior systemic treatments.
Action Required
By June 1, 2026: Billing and clinical teams must implement prior authorization requirements for Elahere (mirvetuximab soravtansine-gynx) for Ohio Medicaid patients. Verify patients meet all 5 clinical criteria including platinum-resistant disease, high folate receptor alpha expression (≥75% tumor cells with 2+ intensity), and 1-3 prior systemic treatments before administration. Update encounter forms to capture required documentation. Claims will be denied without proper prior authorization.