Medicare AdvantagePrior AuthMedium impact
Nexiclon™ XR (clonidine ER) tablet (Revised)
Humana·Pharmacy, Cardiology, Internal Medicine +1 more·Medicare Advantage
Effective date
Oct 26, 2022
We identified it
Jun 25, 2026
Summary
Humana updated its Nexiclon™ XR (clonidine ER) pharmacy coverage policy for Medicare Advantage members, effective October 26, 2022, with a revision dated September 24, 2025. This is a prior authorization (PA) policy requiring members to have a hypertension diagnosis AND prior treatment failure, intolerance, or contraindication to immediate-release clonidine before coverage is approved. Billing teams must ensure prior authorization is obtained before dispensing and verify member eligibility against both criteria.
Action Required
By September 24, 2025: Billing and pharmacy teams must implement prior authorization workflow for Nexiclon™ XR (clonidine ER) for all Medicare Advantage members. Update pharmacy systems and billing software to: (1) Flag prescriptions for Nexiclon™ XR requiring prior auth before dispensing, (2) Require documentation of hypertension diagnosis (ICD-10: I10 or equivalent), (3) Verify member has prior failed treatment, documented intolerance, or contraindication to immediate-release clonidine HCl tablets in member record before approval, (4) Set approval duration to initial plan year with renewal authorization required annually. Communicate requirements to prescribing providers and pharmacy staff. Claims submitted without prior authorization will be denied. Reference Humana's PAL (Preauthorization and Notification List) at www.humana.com/PAL for any procedural coding requirements.