MedicaidPrior AuthMedium impact
Elzonris™ (tagraxofusp-erzs)
Humana·IN · Oncology, Hematology, Pediatrics·Medicaid
Effective date
Mar 1, 2026
We identified it
Aug 12, 2026
Summary
Humana Indiana Medicaid has established a new prior authorization policy for Elzonris (tagraxofusp-erzs), a rare cancer treatment for blastic plasmacytoid dendritic cell neoplasm (BPDCN). The policy requires prior authorization with three approval criteria: confirmed BPDCN diagnosis per WHO classification, inpatient capability for initial therapy plus 24-hour observation, and patient age 2 years or older. Initial and renewal approvals are valid for 6 months each.
Action Required
By March 1, 2026: Billing team must implement prior authorization requirement in billing system for all Elzonris (tagraxofusp-erzs) claims submitted to Humana Indiana Medicaid. Before claim submission: (1) Verify patient meets all three criteria (BPDCN diagnosis by WHO classification, inpatient status with 24-hour post-infusion observation capability, age ≥2 years); (2) Obtain prior authorization through Humana's PAL system before treatment initiation; (3) Request initial 6-month approval and plan renewal submissions 30 days prior to expiration. Update intake forms and provider documentation templates to capture inpatient status and WHO-confirmed diagnosis. Notify providers that claims submitted without prior authorization will be denied. Reference Humana's Preauthorization and Notification List (PAL) at www.humana.com/PAL for medically-billed claims coding requirements.