Medicare AdvantagePrior AuthMedium impact
Muscle Relaxants (Revised)
Humana·Family Medicine, Internal Medicine, Orthopedics +4 more·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage implemented a step therapy policy for muscle relaxants requiring patients to have tried generic tizanidine tablets AND baclofen tablets within the past 12 months before coverage approval for other muscle relaxants including Zanaflex, Amrix, Soma, and others.
Action Required
By January 1, 2025: Billing team must ensure prior authorization is obtained for all muscle relaxant prescriptions (Zanaflex, Amrix, cyclobenzaprine ER, Fexmid, Lorzone, Lyvispah, metaxalone, Ontralfy, orphenadrine injection, Soma, carisoprodol, chlorzoxazone) for Humana Medicare Advantage patients. Providers must document previous treatment with both generic tizanidine tablets AND baclofen tablets within the past 12 months. Update EMR templates to capture this required documentation. Claims will require clinical review without proper prior authorization.