MedicaidPrior AuthHigh impact
Opioid Utilization Program - Morphine Milligram Equivalent (MME) (Revised)
Humana·LA · Pain Management, Palliative Care, Oncology +3 more·Medicaid
Effective date
Oct 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Louisiana Medicaid has updated their opioid utilization program requiring prior authorization when daily morphine milligram equivalent (MME) doses exceed 90 mg. The policy establishes specific criteria for approval including diagnosis requirements, PDMP review, and documentation of treatment response.
Action Required
By October 1, 2025: Billing team must update prior authorization workflows for Louisiana Medicaid patients receiving opioid medications when daily MME exceeds 90 mg. Providers must document PDMP review, treatment response, and medical necessity. Update encounter forms to include MME calculation tools and prior auth reminders. Claims for high-dose opioids will be denied without proper prior authorization.