MedicaidPrior AuthMedium impact
Bizengri (zenocutuzumab-zbco)
Humana·OH · Oncology, Pulmonology·Medicaid
Effective date
Jan 1, 2026
We identified it
Aug 6, 2026
Summary
Humana Medicaid (Ohio) has implemented a new prior authorization policy for Bizengri (zenocutuzumab-zbco), effective January 1, 2026. Coverage is limited to NRG1 gene fusion-positive advanced/unresectable/metastatic NSCLC or pancreatic adenocarcinoma patients with at least one prior systemic therapy line, used as monotherapy. Claims will require prior authorization demonstrating medical necessity and meeting all clinical criteria.
Action Required
By January 1, 2026: Billing team must implement prior authorization process for all Bizengri (zenocutuzumab-zbco) claims submitted to Humana Medicaid Ohio. Before submitting claims, obtain prior authorization by verifying: (1) diagnosis of advanced/unresectable/metastatic NSCLC or pancreatic adenocarcinoma with documented NRG1 gene fusion positivity, (2) patient has received at least one prior systemic therapy line, (3) Bizengri will be administered as monotherapy (not in combination), and (4) no prior disease progression on Bizengri. Update billing system to flag all Bizengri requests for mandatory prior auth review. Failure to obtain prior authorization will result in claim denials. Provider staff should verify NRG1 mutation status documentation and prior treatment history before submitting to plan. Reference Humana's PAL portal at www.humana.com/PAL for claim code submissions.