MedicaidPrior AuthMedium impact
Continuity of Care (Revised)
Humana·IN·Medicaid
Effective date
Jul 1, 2024
We identified it
Jun 24, 2026
Summary
Humana updated its Continuity of Care policy for Indiana Medicaid, allowing override of utilization management requirements (step therapy, prior authorization) for members stable on pre-existing medications within 90 days of enrollment. The policy clarifies that off-label and off-evidence drug uses will be denied during this transition period.
Action Required
Immediately: Review all Indiana Medicaid pharmacy claims for members enrolled within the last 90 days. For stable members on pre-existing medications with compendia-supported diagnoses, utilization management can be overridden. Ensure off-label and off-evidence drug uses are flagged for denial. Update pharmacy benefit verification process to check member eligibility start dates and medication stability status.