Medicare AdvantagePrior AuthMedium impact
Ophthalmic Antibiotics (Revised)
Humana·Ophthalmology, Optometry·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage implemented step therapy requirements for brand-name ophthalmic antibiotics (Zymaxid, Azasite, Besivance, etc.), effective January 1, 2026. Patients must now fail or have intolerance to TWO generic ophthalmic antibiotics within the past 12 months before these brand medications will be covered.
Action Required
Immediately: Billing team and providers must obtain prior authorization for brand ophthalmic antibiotics (Zymaxid, Azasite, Besivance, moxifloxacin viscous, besifloxacin) for Humana Medicare Advantage patients. Update EMR templates to document previous treatment failures or intolerances to at least TWO of these generics: ciprofloxacin, levofloxacin, moxifloxacin (generic Vigamox), or ofloxacin eye drops within past 12 months. Visit www.humana.com/PAL for prior authorization forms. Claims will be denied without proper authorization and documentation.