MedicaidPrior AuthMedium impact
Faslodex (fulvestrant) (New)
Humana·OH · Oncology·Medicaid
Effective date
Nov 1, 2025
We identified it
Jun 24, 2026
Summary
Humana has implemented a new prior authorization policy for Faslodex (fulvestrant) injections for Ohio Medicaid patients with hormone receptor-positive breast cancer. The policy requires pre-approval for both monotherapy and combination therapy with specific criteria based on cancer progression and hormone receptor status.
Action Required
By November 1, 2025: Billing team must update prior authorization requirements for Faslodex (fulvestrant) intramuscular injections for Ohio Medicaid patients. Ensure providers obtain prior auth by verifying patient meets criteria for HR-positive breast cancer, menopausal status, and treatment history. Update billing system to flag these cases for pre-approval. Claims will be denied without proper prior authorization.