MedicaidPrior AuthMedium impact
Zaltrap (ziv-aflibercept) (New)
Humana·LA · Oncology, Hematology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 25, 2026
Summary
Humana Louisiana Medicaid has implemented a new prior authorization policy for Zaltrap (ziv-aflibercept) effective January 1, 2026. The policy requires prior auth for this cancer drug when used to treat metastatic colorectal cancer in combination with irinotecan/FOLFIRI chemotherapy, with specific criteria around second-line therapy and prior treatment history. Claims will be denied without proper authorization.
Action Required
By December 31, 2025: Billing team must implement prior authorization requirement for Zaltrap (ziv-aflibercept) intravenous solution in the billing system for Louisiana Medicaid members only. Update billing software to flag all Zaltrap claims for prior auth review before submission. Providers must document: (1) diagnosis of metastatic colorectal cancer, (2) concurrent use with irinotecan or FOLFIRI chemotherapy, and (3) either second-line use with documented disease progression on oxaliplatin regimen OR unresectable metachronous metastases with prior adjuvant FOLFOX/CapeOX therapy. Front desk and clinical staff should verify these criteria at time of service. Flag any claims showing disease progression while already on Zaltrap for denial review. Claims submitted without prior authorization will be denied. Verify all Zaltrap claims reference correct member plan and state (Louisiana Medicaid only) before submission.