Medicare AdvantagePrior AuthMedium impact
Update to Medical Benefit Drug Coverage for Medical Mutual Medicare Advantage Plans
Medical Mutual of Ohio·Oncology, Urology·Pharmacy
Effective date
May 1, 2023
We identified it
Jun 20, 2026
Summary
Effective May 1, 2023, Medical Mutual Medicare Advantage Plans now require prior authorization for Lupron Depot (leuprolide acetate) injections for cancer treatment. Patients must trial Eligard first for prostate, ovarian, breast, and head/neck salivary gland cancers before Lupron Depot will be approved.
Action Required
Immediately: Billing team must update system to require prior authorization for HCPCS codes J1950 and J9217 (Lupron Depot) for Medical Mutual Medicare Advantage patients. Providers must document trial of Eligard before prescribing Lupron Depot for prostate, ovarian, breast, and head/neck salivary gland cancers. Claims will be denied without proper prior authorization.