MedicaidPrior AuthMedium impact
Lutathera (lutetium Lu 177 dotatate) (New)
Humana·IN · Oncology, Nuclear Medicine, Gastroenterology +1 more·Medicaid
Effective date
Nov 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid Indiana has established a new prior authorization policy for Lutathera (lutetium Lu 177 dotatate), a specialized radioactive drug used to treat certain neuroendocrine tumors. The policy requires prior authorization with specific criteria including unresectable/metastatic NET diagnosis, somatostatin receptor-positive imaging, and no prior Lutathera treatment history.
Action Required
Before November 1, 2025: Billing team must update prior authorization workflows for Lutathera (lutetium Lu 177 dotatate) for Indiana Medicaid members. Ensure providers document: 1) Unresectable, locally advanced or metastatic NET diagnosis (gastroenteropancreatic, lung, thymus, or pheochromocytoma/paraganglioma), 2) Somatostatin receptor-positive imaging results, and 3) Confirmation of no prior Lutathera treatment. Update EMR templates to capture required criteria. Claims will be denied without proper prior authorization.