MedicaidCoverageHigh impact
Opioid Days' Supply Limitation (Revised)
Humana·OK · Pain Management, Family Medicine, General Practice +4 more·Medicaid
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid Oklahoma has revised their opioid prescribing limits, restricting opioid-naive patients to a maximum 7-day supply for initial acute pain treatment, while opioid-tolerant patients can receive up to 30 days for non-acute pain. The policy includes specific exemptions for cancer, sickle-cell disease, palliative care, and long-term care facility residents.
Action Required
By January 1, 2025: Billing team must update pharmacy billing systems to enforce quantity limits on opioid prescriptions for Oklahoma Medicaid patients. Providers must document opioid-naive status (no opioid therapy in past 108 days) and limit initial prescriptions to 7-day supplies unless patient meets exemption criteria (cancer, sickle-cell disease, palliative care, long-term care facility resident, or opioid-tolerant). Update encounter forms to include opioid history screening and exemption checkboxes to prevent claim denials for excess quantities.