Medicare AdvantagePrior AuthMedium impact
Orphenadrine Products (Revised)
Humana·Family Medicine, Internal Medicine, General Practice +3 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for orphenadrine combination products (Norgesic, Norgesic Forte, Orphengesic Forte) effective January 1, 2026. Members must have tried and failed baclofen and tizanidine first, and cannot have certain contraindications like glaucoma or GI obstruction.
Action Required
Before January 1, 2026: Billing team must update prior authorization requirements for orphenadrine combination products (Norgesic, Norgesic Forte, Orphengesic Forte) in billing system for Humana Medicare Advantage plans. Providers must document previous treatment failure or contraindication to baclofen and tizanidine, and verify absence of exclusion conditions (glaucoma, GI obstruction, myasthenia gravis). Update encounter forms to include prior auth reminder for these medications.