MedicaidPrior AuthMedium impact
Quantity Limitation (New)
Humana·LA·Medicaid
Effective date
Jul 1, 2026
We identified it
Jul 2, 2026
Summary
Humana Medicaid Louisiana implemented a new Quantity Limitation guidance policy effective July 1, 2026, establishing maximum allowable quantities for medications across all therapeutic classes. Quantity limits will be applied regardless of formulary status, with exceptions available for dosage titration, literature-supported dosing, failed therapy, or individual member characteristics. Billing teams must be prepared to handle quantity limit exceptions and prior authorization requests based on documented medical necessity.
Action Required
By June 15, 2026: Billing and prior authorization teams must review Humana's specific quantity limits for medications commonly prescribed in your practice (limits are not detailed in this guidance document—contact Humana's Pharmacy & Therapeutics Committee or visit www.humana.com/PAL for the actual medication-specific limits). Update internal workflows to: (1) screen all pharmacy claims against Humana quantity limits before submission; (2) prepare exception request templates with supporting documentation (FDA-approved dosing, peer-reviewed literature, prior failure, or individual member characteristics); (3) train staff to recognize when prescriptions exceed limits and initiate prior authorization. For claims that exceed limits, submit exception requests with required clinical documentation to support approval. Failure to manage quantity limits may result in claim denials or member coverage delays. Communicate with providers in your network about these limits to prevent unnecessary claim rejections.