MedicaidPrior AuthMedium impact
Continuity of Care (Revised)
Humana·OK·Medicaid
Effective date
Apr 1, 2024
We identified it
Jun 24, 2026
Summary
Humana's Continuity of Care policy for Oklahoma Medicaid allows override of prior authorization, step therapy, and non-preferred drug edits for members stable on existing medications within their first 90 days of eligibility. This ensures uninterrupted pharmacy coverage during the transition period, though certain high-risk medications still require review for appropriate use.
Action Required
Billing and clinical teams should document when Medicaid members are stable on current medications and verify eligibility start dates within 90 days when submitting pharmacy claims. Ensure diagnosis documentation supports compendia-recognized indications. Be aware that some high-risk medications may still require prior authorization review even during the continuity period.