Medicare AdvantagePrior AuthMedium impact
Leuprolide Acetate (Lupron, Lutrate) and Generic Depot Products (Revised)
Humana·Oncology, Urology, OB-GYN +2 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated prior authorization requirements for leuprolide acetate (Lupron, Lutrate) depot products effective January 1, 2026. The policy establishes specific approval criteria and duration limits for six conditions: prostate cancer, endometriosis, fibroids, invasive breast cancer, recurrent ovarian cancer, and central precocious puberty.
Action Required
Before January 1, 2026: Billing team must update prior authorization workflows for all leuprolide acetate depot products (Lupron, Lutrate) for Humana Medicare Advantage patients. Verify diagnosis-specific criteria are met before administration: prostate cancer (advanced or high recurrence risk), endometriosis, anemia due to uterine fibroids, hormone-responsive breast cancer in pre/perimenopausal patients, recurrent ovarian cancer, or central precocious puberty in pediatric patients. Ensure no concomitant LHRH analog use is documented. Claims without proper prior authorization will be denied.