Medicare AdvantagePrior AuthMedium impact
Overactive Bladder Agents (Revised)
Humana·Urology, Family Medicine, Internal Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires step therapy for Oxytrol transdermal patches and Gelnique topical gel for overactive bladder treatment. Members must have tried two of the following medications first: oxybutynin immediate-release, oxybutynin extended-release, solifenacin, Myrbetriq, or Gemtesa before automatic approval is granted for these topical formulations.
Action Required
By January 1, 2025: Providers must document that patients have previously tried at least two of the following medications before prescribing Oxytrol or Gelnique: oxybutynin immediate-release, oxybutynin extended-release, solifenacin, Myrbetriq, or Gemtesa. Update EMR templates to include step therapy documentation checklist for overactive bladder treatments. Prior authorization requests without proper step therapy documentation will be denied.