MedicaidPrior AuthMedium impact
Zusduri (mitomycin) (Revised)
Humana·LA · Oncology, Urology·Medicaid
Effective date
Oct 1, 2025
We identified it
Sep 2, 2026
Summary
Humana Louisiana Medicaid has issued a revised prior authorization policy for Zusduri (mitomycin) intravesical treatment for recurrent low-grade intermediate-risk non-muscle invasive bladder cancer (LG-IR-NMIBC). This is a fresh policy dated August 26, 2026, requiring prior authorization before dispensing. Billing teams must verify patient meets all three coverage criteria (LG-IR-NMIBC diagnosis, documented recurrent disease, no prior Zusduri therapy) and has no bladder perforation exclusion.
Action Required
By October 1, 2025: Billing team must implement prior authorization requirement for Zusduri intravesical kit and Sterile Hydrogel For Zusduri intravesical solution in Humana Louisiana Medicaid claims. Before claim submission: (1) Verify patient has LG-IR-NMIBC diagnosis with documented recurrent disease; (2) Confirm no prior Zusduri therapy (maximum lifetime 6 doses); (3) Confirm no bladder perforation. (4) Submit prior authorization request through Humana's preauthorization system at www.humana.com/PAL using applicable medical and procedural codes. (5) Obtain approval before dispensing medication. Initial approval covers 6 months maximum (6 doses); renewal approval covers additional 6 months maximum (6 doses). Claims submitted without prior authorization will be denied. Update billing software rules and provider notification forms to flag these products as requiring prior auth for Louisiana Medicaid members.