CommercialPrior AuthMedium impact
Differin® (adapalene) and Epiduo® (adapalene and benzoyl peroxide) (Revised)
Humana·Dermatology, Pharmacy·Commercial
Effective date
Jan 1, 2023
We identified it
Jun 25, 2026
Summary
Humana has revised its pharmacy coverage policy for Differin (adapalene) and Epiduo (adapalene and benzoyl peroxide) effective January 1, 2023, with updates as of April 24, 2024. This is a step therapy policy requiring members to have prior treatment with or documented intolerance to at least two of the following: tretinoin (non-micro), adapalene 0.1% gel, or adapalene-benzoyl peroxide 0.1%-2.5% before coverage is approved. The policy covers multiple formulations and strengths across topical gels, creams, lotions, solutions, and swabs.
Action Required
By April 24, 2024: Billing and prior authorization teams must implement step therapy requirements for all Differin and Epiduo claims submitted to Humana Commercial plans. Update authorization protocols to verify member has documented prior treatment or intolerance with at least two of the following: tretinoin (non-micro), adapalene 0.1% gel, or adapalene-benzoyl peroxide 0.1%-2.5% before approving coverage. Providers must document in claims submission which prerequisite medications were previously tried or caused intolerance. Update internal billing systems and templates to capture and verify step therapy criteria. Verify current policy version at http://apps.humana.com/tad/tad_new/home.aspx before processing claims. Claims submitted without documented step therapy compliance will be denied.