Vyloy (zolbetuximab-clzb) (New)

Immediately: Billing and clinical teams must implement prior authorization requirements for Vyloy (zolbetuximab-clzb) for all Louisiana Medicaid members. (1) Contact Humana at the source URL or member services to obtain the complete policy details, including specific authorization criteria, required documentation, and submission procedures. (2) Update billing system to flag Vyloy claims for prior authorization submission before claim submission. (3) Providers must submit prior authorization requests with required clinical documentation before administering the drug. (4) Train front desk and billing staff to verify prior authorization status before scheduling or billing. Failure to obtain prior authorization will result in claim denials and potential member balance issues.