MedicaidPrior AuthMedium impact
Bizengri (zenocutuzumab-zbco)
Humana·IN · Oncology·Medicaid
Effective date
Jan 1, 2026
We identified it
Aug 6, 2026
Summary
Humana Medicaid-Indiana has established a new prior authorization policy for Bizengri (zenocutuzumab-zbco), effective January 1, 2026. This bispecific antibody is now covered for advanced/metastatic NSCLC and pancreatic adenocarcinoma with NRG1 gene fusion positive status in patients with prior systemic therapy. All Bizengri claims require prior authorization and must meet specific clinical criteria to avoid denial.
Action Required
By January 1, 2026: Billing team must implement prior authorization requirement for all Bizengri (zenocutuzumab-zbco) claims in the billing system. Update workflow to require documentation of: (1) diagnosis of advanced/unresectable/metastatic NSCLC or pancreatic adenocarcinoma, (2) NRG1 gene fusion positive status, (3) prior systemic therapy treatment, and (4) confirmation of monotherapy use. Configure system to verify member has NOT experienced disease progression on Bizengri before approval. All claims submitted without prior authorization will be denied. Clinical staff should submit preauthorization requests through Humana's PAL system (www.humana.com/PAL) with required clinical documentation. Providers should be notified of the new authorization requirement immediately.