Medicare AdvantagePrior AuthMedium impact
Opioid Overdose Reversal Medications (Zimhi™) (Revised)
Humana·Emergency Medicine, Family Medicine, Internal Medicine +3 more·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for Zimhi™ (naloxone injection syringe) effective January 1, 2025. Members must have tried generic naloxone injection, generic naloxone nasal spray, or Kloxxado nasal spray within the past 12 months before Zimhi™ can be approved for opioid overdose emergency treatment.
Action Required
Immediately: Update prior authorization procedures for Zimhi™ (naloxone injection syringe) prescriptions. Billing team must verify patients have documentation of trial with generic naloxone injection, generic naloxone nasal spray, or Kloxxado nasal spray within past 12 months before submitting Zimhi™ requests. Create checklist for providers to document previous naloxone trials. Claims without proper prior authorization will be denied.