Medicare AdvantagePrior AuthMedium impact
Ycanth™ (cantharidin) (Revised)
Humana·Dermatology, Pediatrics, Infectious Disease·Medicare Advantage
Effective date
Nov 22, 2023
We identified it
Jun 25, 2026
Summary
Humana has updated its prior authorization policy for Ycanth™ (cantharidin) for treating molluscum contagiosum in Medicare Advantage members. The revised policy (effective November 22, 2023, revised October 22, 2025) requires prior authorization and mandates that members must have failed or been intolerant to conventional therapies (podofilox, cimetidine, imiquimod) before approval. Billing teams must ensure all Ycanth claims include documentation of previous treatment attempts or contraindications to qualify for coverage.
Action Required
By November 30, 2025: Billing and clinical teams must implement the following: (1) All Ycanth requests for Medicare Advantage members require prior authorization submission to Humana before dispensing; (2) Include documentation with every prior auth request proving the member meets BOTH criteria: diagnosis of molluscum contagiosum AND prior treatment/contraindication/intolerance with conventional therapy (podofilox, cimetidine, or imiquimod); (3) Update clinical encounter templates and billing workflows to capture documentation of failed conventional treatments; (4) Front desk and billing staff must flag incomplete prior auth requests that lack evidence of previous treatment attempts, as these will be denied; (5) Consult www.humana.com/PAL for medically billed requests and applicable preauthorization codes. Failure to obtain prior authorization or provide required documentation will result in claim denials and potential patient balance liability.