J9395 Insurance Policy Changes

Faslodex (fulvestrant)

Humana Indiana Medicaid has implemented a new prior authorization policy for Faslodex (fulvestrant) effective November 1, 2025. The policy requires prior authorization for all fulvestrant use in breast cancer treatment, with specific clinical criteria for monotherapy versus combination therapy with CDK 4/6 inhibitors. Billing teams must identify all fulvestrant claims and obtain pre-approval before dispensing to avoid claim denials.