Medicare AdvantagePrior AuthMedium impact
Journavx® (suzetrigine) (Revised)
Humana·Pain Management, Anesthesiology, General Surgery +2 more·Medicare Advantage
Effective date
Apr 23, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for Journavx (suzetrigine), a new non-opioid pain medication for moderate to severe acute pain. Patients must have tried other non-opioid treatments first and either cannot use opioids or have failed opioid therapy.
Action Required
By April 23, 2025: Billing team must ensure providers obtain prior authorization before prescribing Journavx (suzetrigine) for Medicare Advantage patients. Verify patient has tried non-opioid treatments (NSAIDs or gabapentinoids) and document why opioids are inappropriate or ineffective. Prior auth required for initial 180-day approvals and renewals.