MedicaidPrior AuthMedium impact
Zynlonta™ (loncastuximab tesirine-Ipyl) (New)
Humana·LA · Oncology, Hematology·Medicaid
Effective date
Sep 1, 2026
We identified it
Sep 2, 2026
Summary
Humana Medicaid Louisiana has released a new prior authorization policy for Zynlonta (loncastuximab tesirine-Ipyl), effective September 1, 2026. The drug is now covered for adult patients with relapsed/refractory large B-cell lymphoma (DLBCL or HGBL) who have received two or more prior lines of systemic therapy and are using Zynlonta as monotherapy. All claims for this drug require prior authorization before dispensing.
Action Required
By September 1, 2026: Billing team must implement prior authorization requirement for all Zynlonta (loncastuximab tesirine-Ipyl) claims for Louisiana Medicaid members. Update billing software to require prior auth submission before pharmacy claim processing. Clinical staff must verify that patients meet all four approval criteria: (1) diagnosis of DLBCL or HGBL, (2) relapsed or refractory disease, (3) two or more prior lines of systemic therapy, and (4) use as single agent. Exclude patients with prior disease progression on Zynlonta. Train front-desk and billing staff on the four approval criteria and exclusion rule. Communicate policy to oncology providers. Document all prior auth requests in EMR. Claims submitted without prior authorization will be denied.