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Benzodiazepine Limited Days Supply (New)
Act
by Jan 1, 2027
Effective date
Jan 1, 2027
Identified
Oct 28, 2026
Summary
Effective January 1, 2027, Humana Illinois Medicaid implements a new pharmacy coverage policy limiting initial benzodiazepine dispensing to a maximum 14-day supply for new users (no benzodiazepine claim in past 60 days), with prior authorization required for initial claims exceeding this limit. Subsequent fills after the initial dispensing follow standard renewal guidelines. This policy applies to 15 benzodiazepine medications across all formulations.
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What to do
by Jan 1, 2027 · 6 steps
01Billing team must implement prior authorization requirements in the billing system for all benzodiazepine initial fills exceeding 14 days for Illinois Medicaid members.
02Pharmacy staff should verify patient claim history within the past 60 days to determine if a prescription qualifies as 'initial use' requiring the 14-day supply limit.
03Update internal protocols to flag benzodiazepine claims (alprazolam, chlordiazepoxide, clonazepam, clorazepate dipotassium, diazepam, estazolam, flurazepam, lorazepam, oxazepam, quazepam, temazepam, triazolam in all formulations) initiated for long-term therapy.
04Submit requests exceeding the 14-day initial limit to Humana's preauthorization system via www.humana.com/PAL.
05Without prior authorization approval, claims exceeding the 14-day limit will be subject to denial.
06Verify current policy applicability before implementation at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a607a23.
Original notice
Benzodiazepine Limited Days Supply (New)
mcp.humana.com · Always check the source before changing claims.