Medicare AdvantagePrior AuthMedium impact
Lidocaine Patch 5% (Lidoderm®, DermacinRx Lidocan™, Lidocan™ II-V) (Revised)
Humana·Pain Management, Neurology, Endocrinology +4 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for brand-name lidocaine 5% patches (Lidoderm, DermacinRx Lidocan, Lidocan II-V) for five specific conditions. All patients must first try generic lidocaine 5% patch before approval for brand-name versions.
Action Required
Before January 1, 2026: Billing team must update prior authorization workflows for brand-name lidocaine 5% patches for Humana Medicare Advantage patients. Providers must document previous trial of generic lidocaine 5% patch and confirm diagnosis of neuropathic cancer pain, post-herpetic neuralgia, diabetic neuropathy, chronic back pain, or hip/knee osteoarthritis pain. Update encounter forms to remind providers of generic-first requirement. Claims for brand-name patches without prior auth will be denied.