MedicaidCoverageHigh impact
Opioid Days' Supply Limitation
Humana·IN · Pain Management, Family Medicine, Internal Medicine +4 more·Medicaid
Effective date
Jul 1, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicaid Indiana has implemented strict opioid prescribing limits effective July 1, 2024. Opioid-naive patients are limited to 7-day supplies for acute pain, while opioid-tolerant patients can receive 30-day supplies for non-acute pain, with specific exceptions for cancer, sickle cell disease, and palliative care patients.
Action Required
Immediately: Billing team must verify opioid prescription quantities align with new limits before submitting claims. For opioid-naive patients, ensure prescriptions do not exceed 7-day supplies unless patient meets specific exemptions (cancer, sickle cell, palliative care, long-term care facility resident, or opioid-tolerant). Update prior authorization workflows to document patient status and exemption criteria. Claims for quantities exceeding limits without proper documentation will be denied.