Medicare AdvantagePrior AuthMedium impact
Tonmya™ (cyclobenzaprine) (New)
Humana·Rheumatology, Pain Management, Neurology +2 more·Medicare Advantage
Effective date
Feb 25, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage plans now require prior authorization for Tonmya (cyclobenzaprine sublingual tablets) for fibromyalgia treatment. Patients must have a fibromyalgia diagnosis and have tried/failed at least two specific first-line medications before approval.
Action Required
By February 25, 2026: Billing team must update prior authorization requirements for Tonmya (cyclobenzaprine sublingual tablets) in pharmacy billing system for Humana Medicare Advantage members. Providers must document fibromyalgia diagnosis and previous treatment failure/contraindication/intolerance to at least two of the following: pregabalin (immediate release), duloxetine 20mg/30mg/60mg (generic Cymbalta), or gabapentin (immediate release). Create EMR reminder for providers to obtain prior auth before prescribing. Claims will be denied without proper authorization.