Medicare AdvantagePrior AuthHigh impact
Nonsteroidal Anti-Inflammatory Drug Products (Revised)
Humana·Pain Management, Rheumatology, Orthopedics +3 more·Pharmacy
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare has implemented new step therapy requirements for specialty NSAIDs, requiring patients to have tried at least two generic oral NSAIDs within the past 12 months before coverage approval. This affects brand-name and specialty formulations of NSAIDs including Cambia, Zorvolex, Zipsor, and others.
Action Required
By January 1, 2026: Prior to prescribing specialty NSAIDs (Cambia, Zorvolex, Zipsor, Relafen, Elyxyb, etc.), providers must document that patients have had previous treatment within the past 12 months with at least TWO of the following oral generics: diclofenac tablet, ibuprofen (400/600/800mg tablet or 100mg/5mL suspension), meloxicam, celecoxib capsule, or naproxen (250/375/500mg tablet). Update EMR templates to capture this trial history. Billing team must verify step therapy completion before submitting claims to avoid denials.