MedicaidPrior AuthMedium impact
Elrexfio (elranatamab-bcmm) (New)
Humana·OH · Oncology, Hematology·Medicaid
Effective date
Nov 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has added prior authorization requirements for Elrexfio (elranatamab-bcmm), a new subcutaneous cancer treatment for relapsed/refractory multiple myeloma. Prior authorization is required for patients who have received at least four prior therapies and meet specific clinical criteria.
Action Required
Before November 1, 2025: Billing team must implement prior authorization requirements for Elrexfio (elranatamab-bcmm) subcutaneous solution for Humana Medicaid Ohio patients. Update billing system to flag this medication for prior auth. Providers must verify patients meet all four criteria: multiple myeloma diagnosis, relapsed/refractory disease, at least four prior therapies including anti-CD38 monoclonal antibody, proteasome inhibitor, and immunomodulatory agent, and single-agent use. Claims will be denied without proper prior authorization.