Medicare AdvantagePrior AuthMedium impact
Vivjoa® (oteseconazole) (Revised)
Humana·OB-GYN, Infectious Disease, Internal Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has implemented a revised prior authorization policy for Vivjoa® (oteseconazole), a new antifungal treatment for recurrent vulvovaginal candidiasis (RVVC). The policy requires four strict approval criteria including confirmation of ≥3 RVVC episodes in the past year, non-reproductive potential status, and prior treatment failure or intolerance to fluconazole maintenance therapy. Billing teams must implement prior authorization requirements before dispensing this newly approved medication.
Action Required
By January 1, 2025 (retroactively—note revision date of April 23, 2025): Pharmacy and billing teams must implement prior authorization requirements for all Vivjoa® (oteseconazole) prescriptions on Humana Medicare Advantage plans. Create a prior authorization submission checklist requiring documentation of: (1) confirmed RVVC diagnosis, (2) at least three vulvovaginal candidiasis episodes within the past 12 months, (3) member's non-reproductive potential status (postmenopausal or surgically sterile), and (4) evidence of prior treatment, intolerance, or contraindication to 6-month oral fluconazole maintenance course. Update pharmacy dispensing system and billing software to trigger prior authorization request before claim submission. Alert prescribers and pharmacy staff that claims without approved prior authorization will be denied. Reference Humana's Preauthorization and Notification List (PAL) at www.humana.com/PAL for applicable claim codes. Verify this is the current policy version before implementation, as Humana updates policies regularly.