MedicaidPrior AuthMedium impact
Elrexfio (elranatamab-bcmm) (Revised)
Humana·LA · Oncology, Hematology·Medicaid
We identified it
Jul 21, 2026
Summary
Humana has issued a revised Prior Authorization policy for Elrexfio (elranatamab-bcmm) affecting Louisiana Medicaid members. This is a 1-day-old policy update that establishes new prior authorization requirements for this medication. Billing and clinical teams must implement the requirements immediately to avoid claim denials.
Action Required
Immediately: Obtain the complete policy document from the source URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a584826) as only a summary is currently available. Billing team must: (1) Review full prior authorization requirements and criteria for Elrexfio; (2) Update billing system to flag claims for Elrexfio as requiring prior authorization before submission; (3) Notify providers treating Louisiana Medicaid members that prior authorization is now required for this medication; (4) Establish workflow to submit prior authorizations through Humana before dispensing/administering Elrexfio. Clinical staff must document medical necessity per policy requirements. Failure to obtain prior authorization will result in claim denials.