Medicare AdvantagePrior AuthMedium impact
Zoryve (roflumilast) (New)
Humana·Dermatology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has established a new prior authorization policy for Zoryve (roflumilast) topical formulations effective January 1, 2026. The policy covers three indications (plaque psoriasis, atopic dermatitis, and seborrheic dermatitis) with specific clinical criteria requiring documented failure, contraindication, or intolerance to conventional topical treatments before approval. Billing teams must implement prior authorization requirements for all Zoryve claims and ensure providers document treatment history with corticosteroids and other baseline therapies.
Action Required
By January 1, 2026: (1) Billing team must configure EHR/billing system to require prior authorization for all Zoryve (roflumilast) cream and foam prescriptions before claims submission. (2) Update claim submission workflows to route Zoryve prescriptions to PA review process. (3) Providers must document in patient records: diagnosis confirmation, BSA involvement percentage (if applicable), prior treatment attempts with specific corticosteroids and vitamin D products (plaque psoriasis), topical corticosteroids or calcineurin inhibitors (atopic dermatitis), or corticosteroids and antifungals (seborrheic dermatitis), including dates and reason for discontinuation (failure, contraindication, or intolerance). (4) Front desk/clinical staff should add Zoryve PA requirements to provider alert systems and formulary documentation checklists. (5) Verify patient age meets indication-specific criteria (6+ years for cream formulations; 2+ years for 0.05% atopic dermatitis cream; 9+ years for seborrheic dermatitis foam; 12+ years for plaque psoriasis foam). Claims submitted without required prior authorization or incomplete clinical documentation will be denied.