CommercialPrior AuthMedium impact
Meloxicam oral suspension (Revised)
Humana·Rheumatology, Pediatrics, Internal Medicine +1 more·Commercial
Effective date
Jul 24, 2024
We identified it
Jun 25, 2026
Summary
Humana updated its meloxicam oral suspension prior authorization policy (revised July 24, 2024) for commercial plans. The policy requires prior authorization for meloxicam oral suspension across three indications: osteoarthritis, rheumatoid arthritis, and juvenile rheumatoid arthritis. Coverage requires documented prior therapy failure, contraindication, or intolerance with both meloxicam tablets AND ibuprofen oral suspension, plus exclusion screening for NSAID allergies and recent CABG surgery.
Action Required
By August 24, 2024: Billing and clinical teams must implement prior authorization requirements for meloxicam oral suspension (7.5 mg/5 mL oral suspension). Specifically: (1) Update billing system to flag all meloxicam oral suspension prescriptions for prior auth review before claim submission; (2) Create/update prior auth request templates requiring documentation of: diagnosis (OA, RA, or JRA with age ≥2 years for JRA), prior therapy failure/contraindication/intolerance with BOTH meloxicam tablets AND ibuprofen oral suspension, and screening for NSAID allergies/asthma/urticaria history and recent CABG surgery; (3) Brief providers and clinical staff on the dual-therapy prior authorization requirement (both meloxicam tablets and ibuprofen suspension must have been tried); (4) Update encounter forms and EMR templates to capture required clinical documentation. Note: Approval duration is plan year or as determined through clinical review. Claims submitted without prior authorization will be denied. Refer to Humana's TAD portal at http://apps.humana.com/tad/tad_new/home.aspx to verify current policy version before submitting requests.