MedicaidPrior AuthMedium impact
Elzonris™ (tagraxofusp-erzs)
Humana·LA · Oncology, Hematology, Pediatrics·Medicaid
Effective date
Mar 1, 2026
We identified it
Aug 12, 2026
Summary
Humana Medicaid-Louisiana has implemented a new prior authorization policy for Elzonris™ (tagraxofusp-erzs), a CD123-directed cytotoxin used to treat blastic plasmacytoid dendritic cell neoplasm (BPDCN). The policy requires prior authorization with three approval criteria: confirmed BPDCN diagnosis per WHO classification, inpatient admission capability for at least the first complete treatment course plus 24-hour observation, and patient age 2 years or older. Coverage is approved for initial and renewal periods of 6 months or as determined through clinical review.
Action Required
By March 1, 2026: Billing team must implement prior authorization workflow for Elzonris (tagraxofusp-erzs) infusions for Louisiana Medicaid members. (1) Update billing system to flag all Elzonris claims as requiring prior auth before submission. (2) Create/update prior auth request template to verify: member has WHO-classified BPDCN diagnosis, member can be admitted as inpatient for full treatment course plus 24-hour observation minimum, and member age ≥2 years. (3) Notify providers and infusion centers that Elzonris cannot be administered without prior authorization approval. (4) Configure system to allow 6-month approval periods with renewal tracking. (5) Route all Elzonris prior auth requests to Humana's medical review department per PAL guidelines at www.humana.com/PAL. Claims submitted without prior authorization approval will be denied. Store copy of this policy document for reference and verification of current version before processing claims.