CommercialPrior AuthMedium impact
Baclofen Products (Fleqsuvy™, baclofen oral solution, baclofen oral suspension, Ozobax™, Lyvispah™) (Revised)
Humana·Pharmacy, Neurology, Pain Management +1 more·Commercial
Effective date
Apr 24, 2024
We identified it
Jun 25, 2026
Summary
Humana revised its prior authorization policy for baclofen oral products (Fleqsuvy, Ozobax, Lyvispah, and generic baclofen solutions/suspensions) effective April 24, 2024. The policy maintains prior authorization requirements for patients age 12+ with spasticity, muscle spasm, myoclonus, or muscle rigidity from multiple sclerosis or spinal cord injury/disease who have failed or are intolerant to baclofen tablets and tizanidine tablets. No specific coverage changes are documented in this revision, but the policy has been formally reviewed and updated.
Action Required
By April 24, 2024: Billing team must verify that pharmacy system reflects the current prior authorization requirements for all baclofen oral products (Fleqsuvy, Ozobax DS, Ozobax, Lyvispah, generic baclofen oral solution, and generic baclofen oral suspension). Confirm that prior authorization is required before claim submission for Humana commercial members. Pharmacy staff should verify member meets all three criteria: (1) indication for spasticity/muscle spasm/myoclonus/muscle rigidity from MS or spinal cord injury/disease, (2) age 12 or older, and (3) prior treatment or intolerance to baclofen tablets AND tizanidine tablets. Refer to Humana's TAD portal (http://apps.humana.com/tad/tad_new/home.aspx) for the most current policy version. Claims submitted without meeting all three criteria or without prior authorization will be denied.