Medicare AdvantagePrior AuthMedium impact
Relistor® (methylnaltrexone) (Revised)
Humana·Pain Management, Palliative Care, Oncology +2 more·Medicare Advantage
Effective date
Jan 1, 2024
We identified it
Jun 24, 2026
Summary
Humana has updated prior authorization requirements for Relistor® (methylnaltrexone) for opioid-induced constipation treatment. The policy requires failure of specific medications (lubiprostone AND Movantik for chronic non-cancer pain, or lactulose for palliative care patients) before approving Relistor.
Action Required
Immediately: Billing team must update prior authorization protocols for Relistor® prescriptions to verify patients have failed lubiprostone AND Movantik (for chronic non-cancer pain) or lactulose (for palliative care) before submitting authorization requests. Providers must document 4+ weeks of opioid use for non-cancer pain cases and ensure proper diagnosis coding for opioid-induced constipation. Claims will be denied without meeting these step therapy requirements.