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Benzodiazepine Limited Days' Supply (Revised)
Act
by Apr 30, 2025
Effective date
Apr 30, 2025
Identified
Jun 25, 2026
Summary
Humana has revised its benzodiazepine limited days' supply policy, effective April 30, 2025. All benzodiazepine medications across Medicare, LINET, Puerto Rico, and three state Medicaid programs (South Carolina, Oklahoma, Virginia) are now subject to strict day supply limits: 30 days for Medicare/LINET/SC/OK Medicaid, 31 days for Medicare/LINET LTC residents, and 34 days for Virginia Medicaid. This policy aims to reduce overdose risk and prevent medication waste, and applies regardless of tier or formulary coverage.
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What to do
by Apr 30, 2025 · 7 steps
01Billing and pharmacy teams must immediately implement days' supply limits on all benzodiazepine claims.
02Update billing system software and pharmacy management systems to enforce maximum fills: 30 days for Medicare/LINET/South Carolina Medicaid/Oklahoma Medicaid members, 31 days for Medicare/LINET long-term care facility residents, and 34 days for Virginia Medicaid members.
03Configure system alerts to block or reject prescription fills exceeding these limits regardless of formulary tier.
04Notify all prescribing providers in the practice of the new restrictions and educate staff on the specific day limits by plan type and state.
05Train front desk and pharmacy staff to inform patients that benzodiazepine refills will be capped at these limits.
06Failure to comply will result in claim denials and may trigger fraud/abuse investigations.
07Verify the current policy version on Humana's website before processing claims, as printed versions become uncontrolled.
Original notice
Benzodiazepine Limited Days' Supply (Revised)
mcp.humana.com · Always check the source before changing claims.