Medicare AdvantagePrior AuthMedium impact
Zilxi® (minocycline) Topical Foam (New)
Humana·Dermatology·Medicare Advantage
Effective date
Jul 23, 2025
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has implemented a new prior authorization requirement for Zilxi® (minocycline) topical foam, effective July 23, 2025. Providers must document that patients have failed or have contraindications to topical metronidazole AND non-delayed release oral doxycycline before Zilxi can be approved for treating inflammatory lesions of rosacea. Claims submitted without meeting all three criteria will require prior authorization.
Action Required
By July 23, 2025: Billing team must implement prior authorization workflow for all Zilxi (minocycline) topical foam claims on Humana Medicare Advantage plans. Update billing software and claim submission procedures to: (1) flag all Zilxi claims for prior authorization review, (2) require providers to submit documentation confirming patient has had previous treatment, intolerance, or contraindication with BOTH topical metronidazole AND non-delayed release oral doxycycline before approval, and (3) ensure prior auth is obtained before claim submission or resubmission. Front desk staff must alert providers that prescription requests for Zilxi require prior authorization and supporting documentation. Claims submitted without prior authorization or incomplete documentation will be denied. Reference the Humana PAL (Preauthorization and Notification List) at www.humana.com/PAL for specific authorization procedures and contact information.