Medicare AdvantagePrior AuthMedium impact
Flector®, Licart™ (diclofenac epolamine patch 1.3%) (Revised)
Humana·Dermatology, Orthopedics, Sports Medicine +5 more·Medicare Advantage
Effective date
Jan 1, 2021
We identified it
Jun 25, 2026
Summary
This is a revised Medicare Advantage prior authorization policy for Flector® and Licart™ (diclofenac epolamine patch 1.3%) effective January 1, 2021, with the most recent revision dated June 24, 2026. The policy requires prior authorization for these topical NSAID patches and limits coverage to acute pain from minor strains, sprains, and contusions in patients 6 years and older. Key contraindications include hypersensitivity to diclofenac, peri-operative CABG pain, aspirin/NSAID reactions, late pregnancy, and history of ulcer disease or GI bleeding.
Action Required
By July 1, 2026: Billing and clinical teams must ensure all requests for Flector® and Licart™ (diclofenac epolamine patch 1.3%) for Medicare Advantage members include prior authorization. Update billing system to flag these medications as requiring prior auth before submission. Verify member eligibility criteria: (1) acute pain diagnosis only (minor strain, sprain, or contusion); (2) patient age 6 years or older; (3) no contraindications present (hypersensitivity, CABG surgery, NSAID/aspirin allergy, late pregnancy, ulcer/GI bleeding history). Provide prior auth requests through www.humana.com/PAL. Claims submitted without prior authorization will be denied. Front desk and clinical staff should screen for contraindications before prescribing. Educate providers that authorizations are limited to plan year duration for initial approval and renewal.