Medicare AdvantagePrior AuthLow impact
Horizant® (gabapentin enacarbil) (Revised)
Humana·Neurology, Pain Management, Pharmacy·Medicare Advantage
Effective date
Jan 28, 2026
We identified it
Jun 25, 2026
Summary
Humana updated its Horizant (gabapentin enacarbil) prior authorization policy effective January 28, 2026. The policy maintains existing coverage criteria for two indications: Restless Legs Syndrome (RLS) requires trial/intolerance/contraindication to both ropinirole AND pramipexole; Postherpetic Neuralgia (PHN) requires prior gabapentin treatment plus either pregabalin or lidocaine topical patch. This is a revision to a policy originally effective January 1, 2018, with no substantive clinical changes in approval criteria.
Action Required
By January 28, 2026: Billing and clinical staff should verify this is the current active policy version in Humana's system (policy documents are frequently updated online). No changes to current prior authorization workflows are required unless your practice was using outdated criteria. Confirm that all Horizant prior authorization requests for Medicare Advantage members continue to follow the existing two-indication pathway: RLS (with documented trial/intolerance/contraindication to both ropinirole and pramipexole) and PHN (with documented prior gabapentin plus pregabalin or topical lidocaine). Reference the official Humana portal at https://dctm.humana.com/Mentor/Web/ for any future updates, as printed copies become uncontrolled. No claim denials are anticipated if current submission practices are maintained.