Medicare AdvantageCoverageMedium impact
Limited Day Supply (Revised)
Humana·SC, IN, OK, VA · Pain Management, Psychiatry, Pharmacy·Medicaid
Effective date
Jan 1, 2019
We identified it
Jun 25, 2026
Summary
Humana revised its Limited Day Supply policy (effective January 1, 2019, with revision date December 24, 2025) to clarify pharmacy coverage limitations across Medicare, LINET, and four Medicaid state programs (South Carolina, Indiana, Oklahoma, Virginia). The policy restricts day supply for specialty drugs (30-day maximum), opioids, benzodiazepines, and approved non-formulary exceptions to prevent waste, abuse, and overdose risk. This is guidance documentation with no new billing codes but requires billing teams to enforce day supply limits at the point of claim adjudication.
Action Required
By January 31, 2026: Billing team must verify that pharmacy claim adjudication systems enforce the following day supply limits: (1) Specialty drugs and drugs on specialty tiers—maximum 30-day supply per fill; (2) Opioids—maximum 30-day supply (reference Opioid Days' Supply Limitation policy for specifics); (3) Benzodiazepines—maximum 30-day supply (reference Benzodiazepine Limited Day's Supply policy); (4) Approved non-formulary exceptions—maximum 31-day supply for LTC facility residents (Medicare/LINET only), otherwise one-month supply per fill. Pharmacy billing staff must deny or manually review claims requesting supplies exceeding these limits for affected medication classes across Humana Medicare Advantage, LINET, and Medicaid (SC, IN, OK, VA) plans. Update claim denial reason codes to reference Limited Day Supply policy. Educate providers in these states that first fills for new therapies and specialty drugs will be capped at 30 days to reduce waste and overdose risk. Failure to enforce limits will result in improper claim payments and potential compliance violations.