Summary
This is a historical policy document (published October 1, 2025, discovered October 23, 2026) establishing Medicaid opioid quantity limits for Louisiana: opioid-naive patients are limited to 7-day supplies for acute pain; opioid-tolerant patients are limited to 30-day supplies for non-acute pain. Exceptions exist for cancer, sickle-cell disease, palliative care, severe burns, and terminal diagnoses. The policy became effective over one year ago and billing teams should verify current applicability with Humana rather than treating discovery as a new mandate.
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What to do
Action · 4 steps
01Already effective October 1, 2025: Verify whether the practice has implemented the Louisiana Medicaid opioid quantity limit edits referenced in this policy (7-day limit for opioid-naive acute pain; 30-day limit for opioid-tolerant non-acute pain) and confirm current applicability with Humana.
02The document was revised November 17, 2025, and is scheduled for review October 6, 2026.
03Before submitting opioid claims for Louisiana Medicaid members, the billing team should confirm this policy remains in effect and that pharmacy or prior authorization workflows reflect the stated day-supply limits and clinical criteria (opioid tolerance status, cancer diagnosis, sickle-cell disease, palliative care, severe burns, or terminal diagnosis).
04Note: The policy text contains a geographic discrepancy (references Indiana Medicaid in background but applies to Louisiana); contact Humana to clarify which state regulations govern your submitted claims.
Original notice
Opioid Days Supply (Revised)
mcp.humana.com · Always check the source before changing claims.