MedicaidPrior AuthMedium impact
Bizengri (zenocutuzumab-zbco)
Humana·LA · Oncology, Pulmonology·Medicaid
Effective date
Jan 1, 2026
We identified it
Aug 6, 2026
Summary
Humana Louisiana Medicaid has established a new prior authorization policy for Bizengri (zenocutuzumab-zbco), effective January 1, 2026. The policy covers NRG1 gene fusion-positive advanced/unresectable/metastatic NSCLC and pancreatic adenocarcinoma in patients with at least one prior line of systemic therapy, requiring prior auth and denying coverage for patients with prior disease progression on the drug.
Action Required
By December 31, 2025: Billing and clinical teams must implement prior authorization requirements for all Bizengri (zenocutuzumab-zbco) claims in Louisiana Medicaid. (1) Update billing system to flag all Bizengri claims for prior auth submission before processing. (2) Establish prior auth workflow requiring verification of: NRG1 gene fusion positive status, advanced/unresectable/metastatic disease diagnosis (NSCLC or pancreatic adenocarcinoma), at least one prior systemic therapy line, and monotherapy use. (3) Train billing and clinical staff that claims will be DENIED without prior authorization. (4) Flag and deny any claims where member has experienced prior disease progression on Bizengri. (5) Configure authorization duration for initial and renewal approvals as per plan year. (6) Ensure providers document black box warning awareness (embryo-fetal toxicity) and contraindications (ILD, anaphylaxis, left ventricular dysfunction) before treatment initiation.