MedicaidPrior AuthMedium impact
Elrexfio (elranatamab-bcmm) (Revised)
Humana·LA · Oncology, Hematology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jul 21, 2026
Summary
This is a revised prior authorization policy for Elrexfio (elranatamab-bcmm), a bispecific BCMA-directed CD3 T-cell engager for relapsed/refractory multiple myeloma in Louisiana Medicaid members. The policy requires prior authorization and mandates that members have received at least four prior lines of therapy (including specific drug classes) and are using Elrexfio as a single agent. Members with prior disease progression on BCMA-directed regimens are excluded.
Action Required
By January 1, 2026: Billing and clinical teams must implement prior authorization requirements for Elrexfio (elranatamab-bcmm) claims for Louisiana Medicaid members. Specifically: (1) Configure billing system to require prior authorization before adjudication; (2) Ensure prior authorization request documentation includes verification of: multiple myeloma diagnosis with relapsed/refractory disease, documentation of at least four prior lines of therapy including daratumumab (or anti-CD38 monoclonal antibody), proteasome inhibitor (e.g., bortezomib), and immunomodulatory agent (e.g., lenalidomide), and confirmation that Elrexfio is being used as single agent therapy; (3) Flag and deny claims where member has experienced prior disease progression on BCMA-directed CD3 T-cell engager regimens; (4) Train providers that Elrexfio is only available through the REMS program and educate on black box warnings for Cytokine Release Syndrome and neurologic toxicity (ICANS); (5) Update claim submission guidance to reference Humana's PAL website for applicable medical billing codes. Claims submitted without required prior authorization documentation will be denied. Revision date July 22, 2026 indicates this is the most current version for Louisiana Medicaid.