Sarclisa (isatuximab-irfc) (Revised)

Before submitting any Sarclisa (isatuximab-irfc) claims for Humana Medicare, Medicaid-Florida, Medicaid-Kentucky, or Medicaid-South Carolina members: (1) Billing and prior authorization teams must verify patient eligibility against all three treatment pathways and their specific clinical criteria; (2) Confirm member has received required prior therapies per indication (two prior therapies including lenalidomide and proteasome inhibitor for third-line; one prior therapy for relapsed/refractory; newly diagnosed and ineligible for transplant); (3) Verify Sarclisa is being used in the required drug combination for each indication; (4) Check exclusion criteria—deny requests if member has experienced disease progression on prior anti-CD38 inhibitor therapy; (5) Submit prior authorization request before dispensing; (6) Document corticosteroid omission if intolerance/contraindication exists; (7) Plan for 6-month approval duration initially, then renewal authorizations every 6 months. Failure to obtain prior authorization will result in claim denials. Update your prior authorization system and clinical criteria checklist to reflect these three distinct pathways with their specific drug combinations and prior therapy requirements.