Medicare AdvantagePrior AuthMedium impact
Nonsteroidal Anti-Inflammatory Drug Products (Revised)
Humana·Rheumatology, Pain Management, Emergency Medicine +4 more·Pharmacy
Effective date
Jan 1, 2026
We identified it
Jul 21, 2026
Summary
Humana Medicare implemented a revised step therapy policy for NSAID products effective January 1, 2026 (updated July 22, 2026). The policy requires members to have documented prior treatment with at least TWO generic NSAIDs (diclofenac, ibuprofen, meloxicam, celecoxib, or naproxen) within the past 12 months before approval for brand-name or specialty NSAID formulations. The policy also reinforces cardiovascular and gastrointestinal contraindications and pregnancy warnings.
Action Required
By December 15, 2025: Billing team must configure authorization system to enforce step therapy requirements for all NSAIDs listed in the policy (Cambia, Zorvolex, Relafen, Elyxyb, Vyscoxa, Zipsor, Naprelan CR, diclofenac potassium formulations, fenoprofen, ketoprofen, and others). Prior to claim submission, verify member treatment history for documented use of at least 2 generic NSAIDs (diclofenac tablet, ibuprofen 400/600/800mg tablet or suspension, meloxicam, celecoxib, or naproxen 250/375/500mg tablet) within the past 12 months. If member lacks documented history, obtain prior authorization from Humana before processing claims. Update claim submission procedures and staff training to screen for cardiovascular disease, GI bleeding history, asthma/allergies to NSAIDs, pregnancy status (>30 weeks gestation), and severe heart failure before authorizing therapy. Claims submitted without meeting step therapy criteria will be denied. Providers and front desk staff must capture complete medication history during intake.