Medicare AdvantagePrior AuthMedium impact
Otezla (apremilast) (Revised)
Humana·Dermatology, Rheumatology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated prior authorization criteria for Otezla (apremilast) across multiple conditions including psoriatic arthritis, plaque psoriasis, and Behcet's disease. The policy now requires specific prior therapy failures and includes new extended-release formulations, with stricter step therapy requirements that must be met before approval.
Action Required
Before January 1, 2026: Billing and clinical teams must update prior authorization processes for Otezla (apremilast) prescriptions. Ensure documentation includes required prior therapy failures (2 specific medications for psoriatic arthritis and moderate-severe plaque psoriasis, high-potency topical corticosteroid plus vitamin D product for mild plaque psoriasis, adalimumab for Behcet's disease). Update EMR templates to capture age, weight, and specific contraindication/intolerance details. Failure to meet criteria will result in prior authorization denials.