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HumanaMedicaid · Prior Auth · Medicaid · IN · Oncology, OB-GYN, UrologyMedium impact

Zoladex (goserelin) (Revised)

Act
by Oct 1, 2025
Effective date
Oct 1, 2025
Identified
Sep 2, 2026

Summary

This is a revised Humana Medicaid (Indiana) prior authorization policy for Zoladex (goserelin) effective October 1, 2025. The policy establishes specific approval criteria for four indications: prostate cancer (advanced or high recurrence risk), breast cancer (pre/perimenopausal, hormone receptor positive), endometriosis (3.6 mg only), and endometrial thinning (3.6 mg only, 2-month approval). Key exclusions include concomitant LHRH agent use, pediatric patients under 18, disease progression in breast cancer, and abnormal vaginal bleeding of unknown etiology. Prior authorization is required for all uses.

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What to do

by Oct 1, 2025 · 11 steps
01Billing team must implement prior authorization requirement for all Zoladex (goserelin) claims for Indiana Medicaid members.
02Update billing system to route all Zoladex requests to Humana prior auth process.
03Providers must verify member meets specific criteria before dispensing.
04Prostate cancer—advanced diagnosis or high recurrence risk.
05Breast cancer—pre/perimenopausal status AND hormone receptor positive.
06Endometriosis—3.6 mg dosage only.
07Endometrial thinning—3.6 mg dosage only for patients scheduled for endometrial ablation.
08Screen for exclusions: LHRH concomitant use, age under 18, disease progression (breast cancer only), and abnormal vaginal bleeding of unknown etiology.
09Establish approval durations: prostate/breast cancer = plan year; endometriosis = 6 months; endometrial thinning = 2 months.
10Update denial templates to cite this policy when criteria are not met.
11Claims without prior authorization will be denied by Humana.

Original notice

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

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