Lutathera (lutetium Lu 177 dotatate) (Revised)

By October 8, 2025: (1) Update prior authorization system in billing software to enforce the three mandatory approval criteria: unresectable/locally advanced/metastatic NET diagnosis (gastroenteropancreatic, lung, thymus, or pheochromocytoma/paraganglioma), somatostatin receptor-positive imaging documentation, and no prior Lutathera course (maximum 4 doses at 8-week intervals). (2) Billing team must verify all three criteria are met before submitting PA requests to Humana for affected plan types. (3) Create internal checklist or system alert requiring documentation of: somatostatin receptor imaging results, baseline renal function (serum creatinine, creatinine clearance via Cockcroft-Gault), baseline hepatic markers (transaminases, bilirubin, albumin, INR), and CBC (hemoglobin, platelet count, neutrophil count). (4) Providers must document premedication plan (long-acting octreotide discontinuation for 4 weeks pre-treatment, amino acid infusion 30 minutes before Lutathera, antiemetics). (5) Update claim submission process to flag for dose modification requirements if patient experiences Grade 2+ thrombocytopenia, Grade 3+ anemia/neutropenia, renal toxicity (CCr <40 mL/min or 40% increase in creatinine), hepatotoxicity (bilirubin >3x ULN or albumin <30 g/L with INR >1.5), or Grade 3+ other adverse reactions—these may require dose reduction to 3.7 GBq or treatment discontinuation. (6) Front desk staff and clinical coordinators must verify patient meets all three approval criteria and has required imaging/lab documentation before scheduling Lutathera administration. Failure to obtain proper prior authorization or submit incomplete documentation will result in claim denials from Humana.