CommercialPrior AuthMedium impact
Apadaz® (benzhydrocodone and acetaminophen) (Revised)
Humana·Pain Management, Emergency Medicine, General Surgery +3 more·Commercial
Effective date
Aug 28, 2024
We identified it
Jun 25, 2026
Summary
Humana updated its Apadaz (benzhydrocodone-acetaminophen) prior authorization policy on August 28, 2024. The policy requires prior authorization for this opioid analgesic combination and mandates that members meet strict criteria: acute pain diagnosis, therapy duration ≤14 days, age ≥18 years, and documented inadequate response to or intolerance of specific alternative opioids. Key exclusions include significant respiratory depression, severe unmonitored asthma, and GI obstruction. Initial approval is issued in 30-day durations or as determined by clinical review.
Action Required
Before September 15, 2024: Billing team must implement prior authorization requirements for all Apadaz (benzhydrocodone-acetaminophen) claims for Humana commercial members. Update billing software to flag Apadaz prescriptions and trigger prior auth workflows. Providers must document: (1) acute pain diagnosis, (2) therapy duration ≤14 days, (3) member age ≥18 years, and (4) prior failed treatment or intolerance to hydrocodone-acetaminophen PLUS tramadol-acetaminophen, hydrocodone-ibuprofen, or oxycodone-acetaminophen. Verify members do not have exclusion criteria (respiratory depression, severe asthma, GI obstruction) before submitting. Update encounter forms and provider bulletins to clarify the 14-day maximum duration limit and approval duration of 30 days. All claims submitted without prior authorization will be denied; claims approved will cover up to 30-day supplies. Verify current policy version at http://apps.humana.com/tad/tad_new/home.aspx before processing claims.