MedicaidPrior AuthMedium impact
Zepzelca (lurbinectedin) (New)
Humana·IN · Oncology, Pulmonology·Medicaid
Effective date
Feb 1, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicaid (Indiana) has established a new prior authorization policy for Zepzelca (lurbinectedin) effective February 1, 2026. The policy covers two treatment pathways: single-agent use for metastatic SCLC with prior platinum-based chemotherapy progression, and combination therapy with atezolizumab for extensive-stage SCLC as maintenance after first-line induction. Prior authorization is required for all Zepzelca prescriptions under this plan.
Action Required
By January 31, 2026: Billing team must implement prior authorization requirement for all Zepzelca (lurbinectedin) IV infusions for Humana Medicaid Indiana members. Update billing system and EMR to flag any Zepzelca prescription for PA submission before claim processing. Providers must document: (1) metastatic SCLC diagnosis with prior platinum-based chemotherapy progression (single-agent pathway) OR extensive-stage SCLC with no progression after atezolizumab/carboplatin/etoposide induction followed by maintenance with atezolizumab combination (combination pathway). Front desk and clinical staff should add Zepzelca to the standing PA requirements list for oncology. Route all requests to Humana PA portal or phone line. Claims submitted without prior authorization will be denied for Indiana Medicaid members.