Medicare AdvantagePrior AuthHigh impact
Long Acting Opioids (Revised)
Humana·Pain Management, Family Medicine, Internal Medicine +2 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has implemented a step therapy policy for long-acting opioids requiring patients to try at least TWO specific first-line opioids (morphine ER tablet, fentanyl patch, buprenorphine weekly patch, or tramadol ER tablet) before accessing other long-acting opioid formulations like OxyContin, hydrocodone ER, or other brand/specialty options.
Action Required
Before January 1, 2026: Billing team must update prior authorization workflows for all long-acting opioid prescriptions for Humana Medicare Advantage patients. Providers must document trial and failure of at least TWO first-line options (morphine ER tablet, fentanyl patch 12-100mcg, buprenorphine weekly transdermal patch, or tramadol ER tablet) before prescribing other long-acting opioids. Update EMR templates to capture step therapy documentation. Claims for non-preferred long-acting opioids will be denied without proper step therapy documentation.