Medicare AdvantageCoverageMedium impact
MA08.159d, Mirvetuximab soravtansine-gynx (Elahere®)
Independence Blue Cross·Oncology, OB-GYN·Pharmacy
Effective date
Jun 15, 2026
We identified it
Jun 19, 2026
Summary
Medicare Advantage has updated medical necessity criteria for Mirvetuximab soravtansine-gynx (Elahere®), a specialty oncology drug. This change affects coverage requirements and documentation standards for this targeted therapy used in gynecologic cancers.
Action Required
By June 15, 2026: Oncology and gynecology billing teams must review updated medical necessity criteria for Mirvetuximab soravtansine-gynx (Elahere®). Update prior authorization documentation requirements in billing system. Ensure providers document updated medical necessity criteria for all Medicare Advantage patients receiving this therapy. Claims may be denied without proper documentation of medical necessity.