← Back to list
Zoladex (goserelin) (Revised)
Act
by Sep 30, 2025
Effective date
Oct 1, 2025
Identified
Sep 2, 2026
Summary
This is a revised Humana Medicaid (Louisiana) prior authorization policy for Zoladex (goserelin) effective October 1, 2025. The policy establishes specific clinical criteria and exclusions for four approved indications: prostate cancer, breast cancer, endometriosis, and endometrial thinning. Billing teams must verify prior authorization requirements before claim submission and ensure member eligibility against specific criteria including age restrictions, concomitant medication exclusions, and dosage-form requirements.
Get alerts when payers change rules like this one
We check Humana and other payers every day and email you when a change matches your specialty and state.
Get Humana alertsPolicy Monitoring is free. No card required.
What to do
by Sep 30, 2025 · 9 steps
01Billing and prior authorization teams must review and implement this Humana Medicaid Louisiana policy for Zoladex (goserelin).
02Update billing system and PA workflow to require prior authorization for all four indications (prostate cancer, breast cancer, endometriosis, endometrial thinning).
03Configure system to enforce exclusion rules: deny PA if member is <18 years old, has concomitant LHRH agents, has abnormal vaginal bleeding of unknown etiology, or (for breast cancer) has progressed malignancy.
04For endometriosis and endometrial thinning, verify 3.6 mg dosage is authorized (10.8 mg will require clinical review).
05Update encounter templates and PA request forms to capture required clinical criteria: prostate cancer (advanced diagnosis OR high recurrence risk), breast cancer (pre/perimenopausal status AND ER/PR+ hormone receptor status), endometriosis (diagnosis only), endometrial thinning (scheduled ablation procedure).
06Set approval duration tracking: initial/renewal plan year for prostate/breast cancer; 6-month initial/renewal for endometriosis; 2-month initial/renewal for endometrial thinning.
07Train billing staff that claims submitted without prior authorization or failing to meet documented criteria will be denied by Humana.
08This policy applies ONLY to Louisiana Medicaid members; verify plan type before applying.
09Reference www.humana.com/PAL for specific medical claim codes.
Original notice
Zoladex (goserelin) (Revised)
mcp.humana.com · Always check the source before changing claims.
Related changes
See all Humana changes →Zoladex (goserelin) (Revised)MediumEffective Oct 1, 2025 · MedicaidZoladex (goserelin) (Revised)MediumEffective Jan 1, 2017 · MedicaidZoladex (goserelin) (Revised)MediumEffective Aug 27, 2025 · MedicaidZoladex (goserelin) (New)HighEffective Oct 1, 2025 · MedicaidBrowse every Humana change in the policy list