Medicare AdvantagePrior AuthMedium impact
Ophthalmic Prostaglandins (Revised)
Humana·Ophthalmology·Medicare Advantage
Effective date
Jan 1, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires step therapy for specialty ophthalmic prostaglandin eye drops (Zioptan, Xelpros, Travatan Z, tafluprost, Iyuzeh, Zolymbus) used for glaucoma and ocular hypertension. Patients must have tried two specific first-line prostaglandin analogs before these specialty drops will be covered.
Action Required
Immediately: Ophthalmology providers must document that patients have previously failed treatment with TWO of the following medications before prescribing specialty prostaglandin drops (Zioptan, Xelpros, Travatan Z, tafluprost, Iyuzeh, Zolymbus): bimatoprost, latanoprost, travoprost, Lumigan, Rocklatan, or Vyzulta. Update prior authorization requests to include this trial history. Claims for specialty drops will be denied without documented step therapy compliance.