Medicare AdvantagePrior AuthMedium impact
Prialt® (ziconotide intrathecal infusion) (Revised)
Humana·Pain Management, Anesthesiology, Neurology·Pharmacy
Effective date
Jan 1, 2024
We identified it
Jun 24, 2026
Summary
Humana has revised their prior authorization policy for Prialt (ziconotide intrathecal infusion) for severe chronic pain management in Medicare patients. The policy maintains strict criteria requiring intolerance to other treatments and excludes patients with psychosis or contraindications to intrathecal therapy.
Action Required
Immediately: Billing and clinical teams must ensure prior authorization is obtained for all Prialt (ziconotide intrathecal infusion) requests for Medicare patients. Verify patient meets all three criteria: intrathecal therapy warranted, intolerance/refractoriness to other treatments including IT morphine, and no exclusionary conditions (psychosis, infection at injection site, bleeding disorders, spinal obstruction). Document medical necessity and previous treatment failures. Claims without proper prior authorization will be denied.