MedicaidPrior AuthLow impact
Loqtorzi™ (toripalimab-tpzi) (New)
Humana·IN · Oncology·Medicaid
Effective date
Feb 1, 2026
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Loqtorzi (toripalimab-tpzi) for nasopharyngeal carcinoma treatment under Indiana Medicaid. Requires prior authorization with specific criteria including metastatic/recurrent locally advanced NPC diagnosis and excludes members who progressed on prior PD-1/PD-L1 inhibitors.
Action Required
By February 1, 2026: Billing team must ensure prior authorization is obtained for all Loqtorzi (toripalimab-tpzi) claims for Indiana Medicaid members. Verify patient meets criteria: metastatic/recurrent locally advanced nasopharyngeal carcinoma, appropriate treatment setting (first-line with cisplatin/gemcitabine or single agent after platinum failure), and no prior progression on PD-1/PD-L1 inhibitors. Claims without prior authorization will be denied.