MedicaidPrior AuthMedium impact
Elrexfio (elranatamab-bcmm) (New)
Humana·IN · Oncology, Hematology·Medicaid
Effective date
Nov 1, 2025
We identified it
Jun 24, 2026
Summary
New Medicaid coverage policy for Elrexfio (elranatamab-bcmm), a cancer drug for multiple myeloma, requiring prior authorization. Patients must meet strict criteria including 4+ prior therapies and cannot have progressed on similar treatments.
Action Required
By November 1, 2025: Billing team must implement prior authorization requirements for Elrexfio (elranatamab-bcmm) subcutaneous solution for Indiana Medicaid patients. Verify patients meet all 4 coverage criteria including multiple myeloma diagnosis, relapsed/refractory disease, 4+ prior therapies (anti-CD38, proteasome inhibitor, immunomodulatory agent), and single-agent use. Ensure exclusion screening for prior BCMA-directed therapy progression. Visit www.humana.com/PAL for specific medical billing codes.