MedicaidPrior AuthLow impact
Elzonris™ (tagraxofusp-erzs) (New)
Humana·OH · Hematology, Oncology·Medicaid
Effective date
Mar 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has established a new prior authorization policy for Elzonris (tagraxofusp-erzs), a rare cancer medication for blastic plasmacytoid dendritic cell neoplasm (BPDCN). Prior authorization is required with specific criteria including WHO-classified BPDCN diagnosis, inpatient capability for first course plus 24-hour observation, and patient age 2+ years.
Action Required
Before March 1, 2026: Billing team must update prior authorization system to require pre-approval for Elzonris (tagraxofusp-erzs) for Ohio Medicaid patients. Ensure providers document WHO-classified BPDCN diagnosis, inpatient treatment capability, and patient age 2+ years. Update encounter forms to include prior auth reminder. Claims will be denied without proper authorization.