Medicare AdvantagePrior AuthMedium impact
Zaltrap (ziv-aflibercept) (Revised)
Humana·FL, KY, SC · Oncology·Medicaid
Effective date
Jan 1, 2024
We identified it
Jun 25, 2026
Summary
Humana revised its Zaltrap (ziv-aflibercept) prior authorization policy effective January 1, 2024, with the most recent update on November 26, 2025. The policy clarifies coverage criteria for this VEGF inhibitor in metastatic colorectal cancer, requiring prior authorization and specifying that it must be used as second-line therapy following oxaliplatin-containing regimen failure or in specific unresectable metastatic scenarios. Claims will be denied if prior authorization is not obtained or if the member experiences disease progression while on Zaltrap.
Action Required
Before submitting any Zaltrap claims for Medicaid members in Florida, Kentucky, or South Carolina: (1) Billing team must verify that prior authorization has been obtained before claim submission—no claims will be processed without it; (2) Ensure clinical documentation supports one of the following: (a) second-line therapy after disease progression or resistance with oxaliplatin-containing regimen, OR (b) unresectable metachronous metastases with prior adjuvant FOLFOX or CapeOX therapy; (3) Confirm Zaltrap is being used in combination with irinotecan or FOLFIRI chemotherapy; (4) Flag and reject any Zaltrap requests for members who have already experienced disease progression on Zaltrap (this is an automatic exclusion); (5) Update your prior authorization tracking system to capture these specific criteria and route all Zaltrap requests through clinical review before billing. Effective immediately for Medicare Advantage and Medicaid plans: Implement these requirements in your EMR/billing system to prevent denials.