Medicare AdvantagePrior AuthMedium impact
Lidocaine 5% topical patch (Revised)
Humana·Pain Management, Dermatology, Oncology +4 more·Medicare Advantage
Effective date
Jan 1, 2020
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage revised its Lidocaine 5% topical patch prior authorization policy effective January 1, 2020, with the most recent revision dated November 26, 2025. The policy covers five indicated diagnoses (neuropathic cancer pain, post-herpetic neuralgia, diabetic neuropathy, chronic back pain, and hip/knee osteoarthritis pain) and requires prior authorization for all uses. Approval is granted for plan year duration for both initial and renewal requests when diagnostic criteria are met.
Action Required
Immediate action required: (1) Billing team must verify all Lidocaine 5% topical patch claims for Medicare Advantage members require prior authorization before submission. (2) Update billing system to trigger prior auth workflows for any claim containing Lidocaine 5% patches across all five covered indications: neuropathic cancer pain, post-herpetic neuralgia, diabetic neuropathy, chronic back pain, and pain associated with hip or knee osteoarthritis. (3) Providers must document the specific qualifying diagnosis on all prescription requests and prior authorization submissions. (4) Claims submitted without prior authorization will be denied. (5) Renewal approvals are valid for the plan year duration; ensure tracking systems flag renewals appropriately. (6) Note: Policy applies to Medicare Advantage only; verify member plan type before applying these requirements. For specific medical billing code requirements, visit www.humana.com/PAL and select applicable Preauthorization and Notification Lists.