MedicaidPrior AuthMedium impact
Zusduri (mitomycin) (New)
Humana·IN · Urology, Oncology·Medicaid
Effective date
Oct 1, 2025
We identified it
Jun 25, 2026
Summary
Humana Indiana Medicaid now requires prior authorization for Zusduri (mitomycin) intravesical treatment of recurrent low-grade intermediate-risk non-muscle invasive bladder cancer. Coverage is limited to a maximum of 6 doses over 6 months, with patients ineligible if they have prior Zusduri therapy or bladder perforation. This is a new policy effective October 1, 2025.
Action Required
By September 15, 2025: Billing team must implement prior authorization workflow for Zusduri (mitomycin) intravesical kit and Sterile Hydrogel for Zusduri in the billing system for all Indiana Medicaid claims. Update claim submission procedures to capture three eligibility criteria: (1) LG-IR-NMIBC diagnosis documentation, (2) recurrent disease confirmation, and (3) verification of no prior Zusduri therapy (maximum 6 doses). Flag claims for denial if bladder perforation is documented. Providers must document all three criteria on encounter forms before billing. Communicate policy requirements to urology department and any providers who treat bladder cancer. Failure to obtain prior authorization will result in claim denials for Indiana Medicaid members.