← Back to list
Opioid Days' Supply Limitation (Revised)
Effective date
Oct 30, 2024
Identified
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its opioid days' supply limitation policy effective October 30, 2024. The policy enforces strict quantity limits: opioid-naive patients are limited to 7 days' supply for acute pain, and opioid-tolerant patients are limited to 30 days' supply for non-acute pain (31 days for long-term care residents). Multiple clinical exceptions exist for cancer, sickle-cell disease, palliative care, and other qualifying diagnoses. Billing teams must ensure claims comply with these limits or face denials at point-of-sale.
Get alerts when payers change rules like this one
We check Humana and other payers every day and email you when a change matches your specialty and state.
Get Humana alertsPolicy Monitoring is free. No card required.
What to do
Action · 8 steps
01REQUIREMENTS: By November 15, 2024: Billing and pharmacy staff must review and update all opioid prescription processing workflows to enforce the revised days' supply limits.
02Billing team: Configure billing software to flag any opioid fills exceeding 7 days for opioid-naive patients or 30 days for opioid-tolerant patients.
03Providers: Document opioid-naïve vs. opioid-tolerant status clearly on all opioid prescriptions; reference claim history within past 108 days to determine status.
04Prior authorization reviewers: Apply clinical exception criteria when providers request supply beyond limits—verify active cancer diagnosis, sickle-cell disease, palliative care status, LTC facility residence, or MED dose medical necessity attestation before approval.
05Front-desk/pharmacy staff: Verify eligible ICD-10 diagnosis codes on file that support pain management exceptions.
06All staff: Do NOT approve opioid fills for patients concurrently receiving medication-assisted addiction treatment.
07Failure to enforce these limits will result in automatic claim denials and point-of-sale rejections for non-compliant prescriptions.
08This is a quantity limit policy subject to CMS PQA High Dose Opioid Use measures, and non-compliance may impact plan quality ratings.
Original notice
Opioid Days' Supply Limitation (Revised)
mcp.humana.com · Always check the source before changing claims.
Related changes
See all Humana changes →Limited Day Supply (Revised)MediumEffective Jan 1, 2019 · MedicaidOpioid Days' Supply Limitation (Revised)HighEffective Jan 1, 2025 · MedicaidOpioid Days' Supply LimitationHighEffective Jul 1, 2024 · MedicaidOpioid Days Supply (Revised)HighEffective Oct 1, 2025 · MedicaidBrowse every Humana change in the policy list