Medicare AdvantagePrior AuthMedium impact
Zelsuvmi™ (berdazimer) (New)
Humana·Dermatology, Pediatrics, Infectious Disease·Medicare Advantage
Effective date
Aug 27, 2025
We identified it
Jun 25, 2026
Summary
Humana has established a new prior authorization policy for Zelsuvmi (berdazimer) topical gel, effective August 27, 2025, for the treatment of molluscum contagiosum in Medicare Advantage members. Coverage requires two criteria: confirmed diagnosis of molluscum contagiosum AND prior treatment failure, contraindication, or intolerance with conventional therapies (podofilox, cimetidine, or imiquimod). Billing teams must implement prior authorization requirements immediately.
Action Required
By August 27, 2025: Billing team must implement prior authorization workflow for Zelsuvmi (berdazimer) topical gel claims for all Medicare Advantage members. (1) Update billing system to flag all Zelsuvmi claims as requiring prior authorization; (2) Create authorization request template requiring documentation of: patient diagnosis of molluscum contagiosum AND evidence of prior treatment failure/contraindication/intolerance with at least one conventional therapy (podofilox, cimetidine, or imiquimod); (3) Educate providers and front desk staff that claims will be denied without prior authorization approval; (4) Establish process to submit PA requests to Humana before dispensing medication. Contact Humana through www.humana.com/PAL for medical/procedural coding and PA submission details.