Medicare AdvantagePrior AuthMedium impact
Sprix (ketorolac tromethamine) nasal spray (Revised)
Humana·Pain Management, Emergency Medicine, General Surgery +1 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for Sprix (ketorolac tromethamine) nasal spray for acute pain management. Patients must have moderate to moderately-severe acute pain, limit use to 5 days maximum, and have failed trials of at least two specified oral medications including ketorolac, meloxicam, celecoxib, naproxen, ibuprofen, diclofenac, or tramadol.
Action Required
Before January 1, 2026: Billing team must update prior authorization workflows for Sprix (ketorolac tromethamine) nasal spray prescriptions for Medicare Advantage patients. Providers must document diagnosis of moderate to moderately-severe acute pain, confirm treatment duration will not exceed 5 days, and document failed trials of at least two oral alternatives (ketorolac, meloxicam, celecoxib, naproxen, ibuprofen, diclofenac, or tramadol 50mg). Add prior auth requirement to pharmacy ordering system and create documentation checklist for providers.