MedicaidPrior AuthHigh impact
Zusduri (mitomycin) (New)
Humana·LA · Oncology, Urology·Medicaid
Effective date
Oct 1, 2025
We identified it
Jun 25, 2026
Summary
Humana Louisiana Medicaid is establishing a new prior authorization requirement for Zusduri (mitomycin) intravesical treatment effective October 1, 2025. This covers a new indication for recurrent low-grade intermediate-risk non-muscle invasive bladder cancer (LG-IR-NMIBC) with a maximum of 6 weekly doses per authorization period. Billing teams must implement prior auth workflows immediately for all Zusduri intravesical kit requests.
Action Required
By October 1, 2025: Billing team must implement prior authorization requirement for all Zusduri (mitomycin) intravesical kit and sterile hydrogel requests for Louisiana Medicaid members. Update billing system to flag Zusduri claims for mandatory prior auth submission before processing. Providers must verify member meets all three criteria: (1) diagnosed with LG-IR-NMIBC, (2) documented recurrent disease, (3) no prior Zusduri therapy. Verify member does NOT have bladder perforation (exclusion criterion). Initial approval covers 6 months or maximum 6 doses; renewal approval also covers 6 months or maximum 6 doses. Contact Humana PAL portal at www.humana.com/PAL for applicable medical and procedural coding. Failure to obtain prior authorization will result in claim denials.