MedicaidPrior AuthHigh impact
Opioid Utilization Program - Morphine Milligram Equivalents (MME) edits (Revised)
Humana·IN · Pain Management, Oncology, Palliative Care +3 more·Medicaid
Effective date
Mar 12, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Indiana has implemented strict morphine milligram equivalent (MME) limits for opioid prescriptions, requiring prior authorization when daily doses exceed 90 MME for all opioids or 60 MME for short-acting opioids only. Clinical review is mandatory for doses above 275 MME (all opioids) or 60 MME (short-acting only), with specific approval criteria for cancer, sickle cell disease, palliative care, and other qualifying conditions.
Action Required
By March 12, 2026: Billing team must implement prior authorization workflows for opioid prescriptions exceeding MME thresholds (90+ MME for all opioids, 60+ MME for short-acting only). Providers must document qualifying conditions (active cancer, sickle cell disease, palliative care, terminal diagnosis, or attempted dose reduction) in medical records. Update EMR templates to include MME calculations and approval criteria checklists. Claims for high-dose opioids without prior authorization will be denied.