Medicare AdvantagePrior AuthHigh impact
Ophthalmic Steroids (Revised)
Humana·Ophthalmology·Medicare Advantage
Effective date
Jan 1, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage is implementing new step therapy requirements for ophthalmic steroid medications. Patients must now try two specific generic eye drops (dexamethasone 0.1%, fluorometholone 0.1%, Lotemax SM, prednisolone acetate 1%, or prednisolone sodium phosphate 1%) within the past 12 months before brand-name ophthalmic steroids will be covered.
Action Required
Immediately: Billing team must verify step therapy compliance for all Humana Medicare Advantage patients prescribed brand-name ophthalmic steroids (Pred Mild, Pred Forte, Inveltys, Alrex, Flarex, FML Forte, FML Liquifilm, Maxidex, Lotemax, Durezol, Byqlovi). Providers must document previous treatment with two of the required generic alternatives within past 12 months before prescribing covered medications. Update prior authorization workflows to include step therapy documentation requirements. Claims will be denied without proper step therapy compliance.