Traditional MedicarePrior AuthLow impact
Loqtorzi™ (toripalimab-tpzi) (Revised)
Humana·FL, KY, SC, VA · Oncology, Hematology·Medicaid
Effective date
Feb 28, 2024
We identified it
Jun 24, 2026
Summary
Humana revised its prior authorization policy for Loqtorzi (toripalimab-tpzi), an IV cancer immunotherapy for nasopharyngeal carcinoma. The policy specifies approval criteria for first-line combination therapy or single-agent use after platinum-containing regimen failure, with 6-month approval durations.
Action Required
Immediately: Billing team must ensure prior authorization is obtained for all Loqtorzi (toripalimab-tpzi) requests for Medicare and Medicaid patients in FL, KY, SC, and VA. Verify patient meets diagnosis criteria for metastatic/recurrent locally advanced nasopharyngeal carcinoma and treatment setting requirements. Document that patient has not progressed on prior PD-1/PD-L1 inhibitors. Claims will be denied without proper prior authorization.