Medicare AdvantagePrior AuthMedium impact
Zepzelca (lurbinectedin) (Revised)
Humana·FL, KY, SC · Oncology, Internal Medicine·Medicaid
Effective date
Dec 17, 2025
We identified it
Jun 25, 2026
Summary
Humana revised its Zepzelca (lurbinectedin) prior authorization policy effective December 17, 2025. The policy covers two treatment pathways for small cell lung cancer: (1) single-agent use for metastatic SCLC with prior platinum-based chemotherapy progression, and (2) combination therapy with atezolizumab for extensive-stage SCLC as maintenance after first-line induction therapy. This is a routine policy update affecting Medicaid plans in Florida, Kentucky, and South Carolina, plus Medicare Advantage.
Action Required
By December 17, 2025: Billing team must implement prior authorization requirements for all Zepzelca (lurbinectedin) IV claims submitted for Humana Medicare Advantage and Medicaid members in Florida, Kentucky, and South Carolina. (1) Update billing system to flag any Zepzelca claims requiring prior auth before submission. (2) For single-agent use: Verify member has metastatic SCLC diagnosis with documented progression on prior platinum-based chemotherapy. (3) For combination therapy: Verify member has extensive-stage SCLC, completed first-line induction with atezolizumab/carboplatin/etoposide WITHOUT progression, and Zepzelca is prescribed with atezolizumab as maintenance. (4) Ensure providers document disease progression status at treatment initiation and monitor for progression during therapy—claims will be denied if member experiences disease progression on Zepzelca. (5) Reference www.humana.com/PAL for applicable preauthorization coding requirements. Failure to obtain prior authorization will result in claim denials.