MedicaidPrior AuthMedium impact
Zepzelca (lurbinectedin) (New)
Humana·OH · Oncology, Pulmonology·Medicaid
Effective date
Feb 1, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicaid (Ohio) 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 therapy after first-line induction. All claims require prior authorization and will be denied if disease progression occurs on Zepzelca.
Action Required
By February 1, 2026: Billing and clinical teams must implement prior authorization requirements for all Zepzelca (lurbinectedin) IV claims for Ohio Medicaid members. (1) Providers must submit prior auth requests documenting: (a) for single-agent use—diagnosis of metastatic SCLC and prior platinum-based chemotherapy progression, or (b) for combination use—diagnosis of extensive-stage SCLC, no disease progression after first-line atezolizumab/carboplatin/etoposide induction, and concurrent atezolizumab use. (2) Update billing system workflows to flag all Zepzelca claims requiring prior authorization submission to Humana before dispensing. (3) Train clinical staff to identify and document exclusions (disease progression on Zepzelca) that will result in claim denial. (4) Communicate with prescribers that claims without approved prior authorization will be denied. Reference Humana's Preauthorization and Notification List (PAL) at www.humana.com/PAL for current medical billing codes.