MedicaidPrior AuthMedium impact
Elzonris™ (tagraxofusp-erzs)
Humana·OH · Oncology, Hematology, Pharmacy·Medicaid
Effective date
Mar 1, 2026
We identified it
Aug 12, 2026
Summary
Humana Ohio Medicaid has issued a new prior authorization policy for Elzonris (tagraxofusp-erzs), effective March 1, 2026, for treatment of blastic plasmacytoid dendritic cell neoplasm (BPDCN) in patients 2 years and older. The policy requires three approval criteria: confirmed BPDCN diagnosis per WHO classification, inpatient capability for the first complete therapy course plus 24 hours observation, and patient age ≥2 years. Prior authorization is mandatory with initial and renewal approvals valid for 6 months.
Action Required
By February 15, 2026: Billing team must implement prior authorization requirements for Elzonris (tagraxofusp-erzs) claims in the Humana Ohio Medicaid system. Update intake and authorization workflows to require documentation of: (1) WHO-confirmed BPDCN diagnosis, (2) inpatient setting confirmation for initial therapy cycle plus 24-hour observation capability, and (3) patient date of birth verification for age ≥2 years requirement. Configure authorization request templates in billing software to capture these three criteria. Notify oncology providers and infusion centers that all Elzonris claims require prior authorization before dispensing; claims submitted without prior auth will be denied. Reference the policy document at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a5a135e for clinical details. Track initial and renewal approvals at 6-month intervals.