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Drug - Zepzelca™ (lurbinectedin injection) [Jazz Pharmaceuticals, Inc.]

March 2021

Therapeutic Area - Oncology

Initial approval criteria

  • Patient is at least 18 years of age AND
  • Patient has a diagnosis of metastatic small cell lung cancer (SCLC) AND
  • Lurbinectedin will be used as a single agent AND
  • Patient has a diagnosis of metastatic disease after disease progression on or after platinum-based chemotherapy (i.e., cisplatin, carboplatin) OR
  • Patient has relapsed or progressive disease as subsequent therapy
  • Initial approval is for 6 months

Renewal criteria

  • Patient demonstrated disease response with treatment as defined by stabilization in disease or decrease in size of tumor/tumor spread AND
  • Absence of unacceptable toxicity from the drug (myelosuppression, hepatotoxicity, etc.)
  • Renewal approval is for 6 months

Quantity limits

  • 3.2 mg/m2 every 21 days
  • Patient’s body surface area (in m2) must be provided at time of request

Billing for Zepzelca

Zepzelca must be billed as a medical claim.


MHCP Provider Call Center 651-431-2700 or 800-366-5411

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