MedicaidPrior AuthMedium impact
Faslodex (fulvestrant) (New)
Humana·IN · Oncology·Medicaid
Effective date
Nov 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid Indiana has established a new prior authorization policy for Faslodex (fulvestrant) effective November 1, 2025. This affects treatment of hormone receptor-positive breast cancer patients requiring specific diagnostic criteria and treatment history documentation for approval.
Action Required
By November 1, 2025: Billing team must implement prior authorization requirements for Faslodex (fulvestrant) intramuscular injections for Indiana Medicaid patients. Providers must document hormone receptor status, HER2 status, menopausal status, prior endocrine therapy history, and treatment plan (monotherapy vs combination). Update EMR templates to capture required criteria. Claims will be denied without proper prior authorization.