MedicaidPrior AuthMedium impact
Sarclisa (isatuximab-irfc) (Revised)
Humana·OH · Oncology, Hematology·Medicaid
Effective date
Dec 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has revised their prior authorization policy for Sarclisa (isatuximab-irfc) for multiple myeloma treatment, effective December 1, 2025. The policy now covers three indications: third-line multiple myeloma, relapsed/refractory multiple myeloma, and newly diagnosed multiple myeloma in transplant-ineligible patients, each with specific combination therapy requirements and prior treatment criteria.
Action Required
By December 1, 2025: Billing and prior authorization teams must update Humana Medicaid Ohio protocols for Sarclisa (isatuximab-irfc) requests to include the new three-indication coverage criteria. Ensure prior authorization requests specify the exact combination therapies (pomalidomide/dexamethasone for third-line, carfilzomib/dexamethasone for relapsed/refractory, or bortezomib/lenalidomide/dexamethasone for newly diagnosed) and document required prior therapies. Verify patients have not experienced disease progression on anti-CD38 inhibitors as this is an exclusion criterion.