Medicare AdvantagePrior AuthMedium impact
Symproic® (naldemedine) (Revised)
Humana·Pain Management, Gastroenterology, Family Medicine +2 more·Medicare Advantage
Effective date
Jan 1, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage revised their prior authorization policy for Symproic® (naldemedine) for opioid-induced constipation. The policy now requires patients to have failed or have contraindications to both lubiprostone AND Movantik before approval, plus meet specific diagnosis and treatment duration criteria.
Action Required
Immediately: When prescribing Symproic® for Medicare Advantage patients with opioid-induced constipation, ensure prior authorization includes documentation of: 1) OIC diagnosis, 2) opioid use for 4+ weeks for non-cancer pain, and 3) previous treatment failure, intolerance, or contraindication to BOTH lubiprostone AND Movantik. Update prior auth request templates to include all three criteria. Claims without proper prior auth will be denied.