MedicaidPrior AuthMedium impact
Zepzelca (lurbinectedin) (New)
Humana·LA · Oncology, Hematology, Pulmonology·Medicaid
Effective date
Feb 1, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicaid Louisiana has established a new prior authorization policy for Zepzelca (lurbinectedin) effective February 1, 2026. The policy covers two treatment pathways: (1) single-agent use for metastatic SCLC with prior platinum-based chemotherapy progression, and (2) combination therapy with atezolizumab for extensive-stage SCLC as maintenance after first-line induction therapy. All Zepzelca claims require prior authorization with specific clinical criteria documentation.
Action Required
By February 1, 2026: Billing and clinical teams must implement prior authorization requirements for all Zepzelca (lurbinectedin) claims submitted to Humana Medicaid Louisiana. (1) Update billing system to flag all Zepzelca requests for prior auth submission. (2) Providers must document at claim submission: diagnosis of metastatic or extensive-stage SCLC, prior platinum-based chemotherapy treatment and progression status, and intended use (single agent vs. combination with atezolizumab). (3) For single-agent pathway: verify progression on platinum-based chemotherapy. (4) For combination pathway: verify extensive-stage SCLC diagnosis and no disease progression after first-line atezolizumab/carboplatin/etoposide induction therapy. (5) Submit prior authorization requests to Humana before dispensing. Claims submitted without prior authorization or failing to meet specified criteria will be denied. Approval duration follows plan year or clinical review determination.