Medicare AdvantagePrior AuthMedium impact
Gralise® (gabapentin) (Revised)
Humana·Neurology, Pain Management, Dermatology +1 more·Medicare Advantage
Effective date
Oct 22, 2025
We identified it
Jun 25, 2026
Summary
Humana revised its Gralise (gabapentin extended-release) coverage policy effective October 22, 2025, maintaining a step therapy requirement for Medicare Advantage members. Prior to Gralise approval, members must have documented previous treatment or intolerance to gabapentin AND at least one alternative agent (lidocaine 5% topical patches or pregabalin). This is a policy clarification/reaffirmation rather than a new restriction, with the same approval duration for initial and renewal periods on a plan year basis.
Action Required
By October 22, 2025: Billing and prior authorization teams must ensure Gralise (gabapentin ER) requests include documentation of: (1) previous gabapentin treatment or intolerance, AND (2) previous treatment or intolerance to at least one of the following—lidocaine 5% topical patches or pregabalin (Lyrica). Update prior authorization templates and clinical review criteria in the authorization system to reflect these dual requirements. Front-line staff should verify this documentation is present before submitting authorization requests to avoid denials. This applies to all Medicare Advantage member requests for Gralise brand or generic gabapentin ER products.