Medicare AdvantagePrior AuthMedium impact
Oxycodone-Acetaminophen (300mg) Products (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 now requires prior authorization for oxycodone-acetaminophen 300mg products (Nalocet, Primlev, Prolate). Patients must have failed or have contraindications to both generic Norco and generic Percocet before these 300mg formulations will be approved.
Action Required
Before January 1, 2026: Providers must obtain prior authorization for all oxycodone-acetaminophen 300mg products (Nalocet, Primlev, Prolate) for Medicare Advantage patients. Document patient has severe pain requiring opioids and has failed/cannot tolerate both hydrocodone-325mg acetaminophen (generic Norco) AND oxycodone-325mg acetaminophen (generic Percocet). Update EMR templates to capture required documentation. Claims will be denied without prior authorization.