MedicaidPrior AuthMedium impact
Elahere (mirvetuximab soravtansine-gynx) (New)
Humana·IN · Oncology, OB-GYN·Medicaid
Effective date
Jun 1, 2026
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Elahere (mirvetuximab soravtansine-gynx), a specialized cancer treatment for platinum-resistant ovarian, fallopian tube, or primary peritoneal cancer. Requires specific criteria including high folate receptor alpha expression and 1-3 prior treatments for Indiana Medicaid members.
Action Required
Before June 1, 2026: Billing and clinical teams must establish prior authorization workflow for Elahere (mirvetuximab soravtansine-gynx) for Indiana Medicaid members. Ensure providers document: 1) epithelial ovarian/fallopian tube/primary peritoneal cancer diagnosis, 2) platinum-resistant disease status, 3) FRα expression ≥75% with 2+ intensity, 4) history of 1-3 prior systemic treatments, and 5) single-agent use. Update EMR templates to capture required criteria. Claims will be denied without proper prior authorization.