MedicaidPrior AuthMedium impact
Zaltrap (ziv-aflibercept) (New)
Humana·OH · Oncology, Pharmacy·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 25, 2026
Summary
Humana Ohio Medicaid has established a new prior authorization requirement for Zaltrap (ziv-aflibercept) effective January 1, 2026. The drug is covered only for metastatic colorectal cancer patients as second-line therapy who have failed oxaliplatin-containing regimens or have unresectable metachronous metastases with prior adjuvant chemotherapy, and must be used in combination with irinotecan or FOLFIRI. Claims will be denied without prior authorization and for patients who progress while on Zaltrap.
Action Required
By January 1, 2026: Billing team must implement prior authorization workflow for Zaltrap (ziv-aflibercept) claims for Ohio Medicaid members. (1) Update billing system to flag all Zaltrap requests requiring prior auth submission. (2) Create authorization checklist requiring verification of: metastatic colorectal cancer diagnosis, combination use with irinotecan or FOLFIRI, and second-line therapy status with documented oxaliplatin resistance OR unresectable metachronous metastases with prior FOLFOX/CapeOX. (3) Update provider communication materials to note exclusion criteria: deny coverage if member has experienced disease progression while on Zaltrap. (4) Route all Zaltrap requests to Humana prior authorization portal (www.humana.com/PAL) before claim submission. (5) Train billing and authorization staff on three approval pathways under Criteria #3. Failure to obtain prior authorization will result in automatic claim denials for Ohio Medicaid members.