MedicaidPrior AuthMedium impact
Zaltrap (ziv-aflibercept) (New)
Humana·IN · Oncology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 25, 2026
Summary
Humana Indiana Medicaid has implemented a NEW prior authorization requirement for Zaltrap (ziv-aflibercept) effective January 1, 2026. This angiogenesis inhibitor for metastatic colorectal cancer now requires approval before dispensing, with specific clinical criteria including second-line therapy status, documented disease progression on oxaliplatin regimens, or unresectable metachronous metastases. Claims will be denied without prior authorization.
Action Required
By December 31, 2025: Billing and clinical teams must implement prior authorization workflow for Zaltrap in the Humana Indiana Medicaid system. (1) Update billing software and prior auth submission protocols to require pre-approval before pharmacy dispensing. (2) Provider office staff must obtain prior authorization by submitting: patient diagnosis of metastatic colorectal cancer, documentation of FOLFIRI or irinotecan combination therapy, AND evidence of either (a) disease progression/resistance on prior oxaliplatin regimen for second-line use, OR (b) unresectable metachronous metastases with prior adjuvant FOLFOX/CapeOX therapy. (3) Ensure providers document disease progression history on Zaltrap is NOT present (exclusion criterion). (4) Attach prescribing information and clinical justification to all prior auth requests. (5) Update EMR templates and encounter forms to flag Zaltrap cases for mandatory prior auth review. Failure to obtain prior authorization will result in claim denials and patient out-of-pocket liability.