Medicare AdvantagePrior AuthMedium impact
Pennsaid (diclofenac topical solution) (Revised)
Humana·Rheumatology, Pain Management, Geriatrics +2 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jul 21, 2026
Summary
Humana Medicare Advantage has updated its Pennsaid (diclofenac topical solution) pharmacy coverage policy, effective January 1, 2026, with a revision dated July 22, 2026. The policy requires prior authorization for all diclofenac topical formulations (brand Pennsaid and generic) when treating osteoarthritis of the knee. Coverage is limited to members with a documented diagnosis of osteoarthritis of the knee(s), approved for the initial and renewal plan year duration.
Action Required
By January 1, 2026: Billing team must implement prior authorization requirement for all Pennsaid and diclofenac topical solution claims (metered-dose pump, drops, and packet formulations) submitted to Humana Medicare Advantage plans. Update billing system to flag these medications for mandatory prior auth before claim submission. Verify member has documented osteoarthritis of knee(s) diagnosis on file before authorizing. Train front desk and billing staff to request prior authorization through Humana's PAL system (www.humana.com/PAL) for all prescriptions. Attach clinical documentation confirming knee osteoarthritis diagnosis to all prior auth requests. Failure to obtain prior authorization will result in claim denials and potential member balance issues.