MedicaidPrior AuthMedium impact
Zoladex (goserelin) (Revised)
Humana·IN · Oncology, OB-GYN, Urology·Medicaid
Effective date
Oct 1, 2025
We identified it
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.
Action Required
By October 1, 2025: Billing team must implement prior authorization requirement for all Zoladex (goserelin) claims for Indiana Medicaid members. Update billing system to route all Zoladex requests to Humana prior auth process. Providers must verify member meets specific criteria before dispensing: (1) Prostate cancer—advanced diagnosis or high recurrence risk; (2) Breast cancer—pre/perimenopausal status AND hormone receptor positive; (3) Endometriosis—3.6 mg dosage only; (4) Endometrial thinning—3.6 mg dosage only for patients scheduled for endometrial ablation. Screen for exclusions: LHRH concomitant use, age under 18, disease progression (breast cancer only), and abnormal vaginal bleeding of unknown etiology. Establish approval durations: prostate/breast cancer = plan year; endometriosis = 6 months; endometrial thinning = 2 months. Update denial templates to cite this policy when criteria are not met. Claims without prior authorization will be denied by Humana.