Medicare AdvantagePrior AuthMedium impact
Topical Antivirals (Revised)
Humana·Dermatology, Family Medicine, General Practice +2 more·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for all topical antiviral medications (acyclovir and penciclovir creams/ointments) with specific clinical criteria that must be met, including previous treatment failure or contraindication to oral antivirals. This policy creates new barriers to accessing these commonly prescribed medications for herpes infections.
Action Required
By January 1, 2025: Providers must obtain prior authorization for all topical antiviral prescriptions (acyclovir cream/ointment, Zovirax cream/ointment, Denavir cream, penciclovir cream) for Humana Medicare Advantage patients. Document previous treatment, contraindication, or intolerance with oral acyclovir and valacyclovir. For cream formulations, confirm diagnosis of recurrent herpes labialis. For ointments, confirm diagnosis of genital herpes or HSV infection in immunocompromised patients. Update EMR templates to capture required documentation. Claims without prior authorization will be denied.