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HumanaMedicaid · Prior Auth · Medicaid · LA · Oncology, OB-GYN, UrologyHigh impact

Zoladex (goserelin) (New)

Act
by Sep 15, 2025
Effective date
Oct 1, 2025
Identified
Jun 25, 2026

Summary

Humana Medicaid (Louisiana) implemented a new Prior Authorization policy for Zoladex (goserelin) effective October 1, 2025, covering four indications: prostate cancer, breast cancer, endometriosis, and endometrial thinning. The policy establishes specific approval criteria, exclusions (including pediatric restrictions and contraindications with other LHRH agents), and varying approval durations by indication. All Zoladex claims in Louisiana Medicaid must now obtain prior authorization before dispensing.

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What to do

by Sep 15, 2025 · 6 steps
01Billing team must configure pharmacy billing system to require prior authorization for HCPCS code J9202 (Zoladex/goserelin injection) for all Louisiana Medicaid members.
02Update prior auth submission templates to capture: (1) member age verification (exclude <18), (2) clinical indication (prostate cancer, breast cancer, endometriosis, or endometrial thinning), (3) for breast cancer: pre/perimenopausal status and hormone receptor (ER/PR) positivity, (4) for endometriosis/endometrial thinning: dosage form confirmation (3.6 mg only), (5) verification of no concomitant LHRH agent use, and (6) for breast cancer: confirmation of no malignant disease progression.
03Providers must submit prior auth requests before dispensing or claims will be denied.
04Pharmacy staff should flag any claims for members <18 years old as automatic denials per policy exclusions.
05Configure renewal parameters: plan year duration for prostate/breast cancer, 6-month for endometriosis, 2-month for endometrial thinning.
06Train all billing and pharmacy personnel on the four distinct approval pathways and their specific criteria.

Codes mentioned

J9202

Original notice

Zoladex (goserelin) (New)
mcp.humana.com · Always check the source before changing claims.
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Related changes

See all Humana changes →
Zoladex (goserelin) (Revised)MediumEffective Aug 27, 2025 · MedicaidZoladex (goserelin) (New)HighEffective Oct 1, 2025 · MedicaidZoladex (goserelin) (Revised)MediumEffective Oct 1, 2025 · MedicaidZoladex (goserelin) (Revised)MediumEffective Oct 1, 2025 · MedicaidBrowse every Humana change in the policy list

Related policy hubs

Humana policiesLA policy changesOncologyOB-GYNUrologyCode J9202

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