MedicaidPrior AuthMedium impact
Vyloy (zolbetuximab-clzb) (New)
Humana·IN · Infectious Disease, General Practice, Internal Medicine·Medicaid
We identified it
Jul 23, 2026
Summary
Humana Indiana Medicaid has implemented a new prior authorization policy for Vyloy (zolbetuximab-clzb), a monoclonal antibody used for Clostridioides difficile infection prevention. Billing teams must obtain prior authorization before administering this drug to Indiana Medicaid members or claims will be denied.
Action Required
Immediately: Billing team and providers must implement prior authorization requirement for Vyloy (zolbetuximab-clzb) for all Indiana Medicaid members. Update billing system and EMR templates to flag this drug for prior auth review before claims submission. Contact Humana Indiana Medicaid at the source URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a5847f5) to obtain specific prior auth submission procedures, required clinical documentation, and approval timeframes. Train front desk and clinical staff on new requirement. Failure to obtain prior authorization will result in claim denials for this medication.