MedicaidPrior AuthMedium impact
Elahere (mirvetuximab soravtansine-gynx) (Revised)
Humana·LA · Oncology, OB-GYN·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
This is a new prior authorization policy for Elahere (mirvetuximab soravtansine-gynx), a cancer drug for platinum-resistant ovarian, fallopian tube, or primary peritoneal cancer. The policy establishes specific criteria including high folate receptor alpha expression and limits to 1-3 prior treatments for Louisiana Medicaid patients.
Action Required
Before January 1, 2026: Billing team must update prior authorization system for Elahere (mirvetuximab soravtansine-gynx) for Louisiana Medicaid patients. Providers must verify patients meet all 5 criteria: epithelial ovarian/fallopian tube/primary peritoneal cancer diagnosis, platinum-resistant disease, high folate receptor alpha expression (≥75% tumor cells with 2+ intensity), 1-3 prior systemic treatments, and single agent use. Claims will be denied without proper prior authorization.