CommercialCoverageMedium impact
08.02.01c, Mirvetuximab soravtansine-gynx (Elahere®)
Independence Blue Cross·Oncology, OB-GYN·Pharmacy
Effective date
Jun 16, 2025
We identified it
Jun 19, 2026
Summary
Medical necessity criteria have been updated for Mirvetuximab soravtansine-gynx (Elahere®), a specialty pharmacy drug used in oncology treatment. The policy change affects coverage requirements and documentation standards for this medication.
Action Required
Before June 16, 2025: Billing and prior authorization teams must review updated medical necessity criteria for Mirvetuximab soravtansine-gynx (Elahere®). Update prior authorization workflows and ensure providers document required medical necessity criteria according to new policy guidelines. Claims may be denied if new criteria are not met.