MedicaidPrior AuthLow impact
Loqtorzi™ (toripalimab-tpzi) (New)
Humana·OH · Oncology·Medicaid
Effective date
Feb 1, 2026
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Loqtorzi (toripalimab-tpzi), a cancer immunotherapy drug for nasopharyngeal carcinoma treatment under Ohio Medicaid. Requires pre-approval with specific criteria including diagnosis confirmation and treatment setting specifications.
Action Required
Before February 1, 2026: Billing team must update prior authorization requirements for Loqtorzi (toripalimab-tpzi) in billing system for Ohio Medicaid patients with nasopharyngeal carcinoma. Ensure providers document metastatic or recurrent locally advanced NPC diagnosis and specify treatment setting (first-line with cisplatin/gemcitabine or single agent after platinum-containing regimen). Claims will require 6-month approvals through clinical review.