Medicare AdvantagePrior AuthLow impact
Hyftor™ (sirolimus topical gel) (Revised)
Humana·Dermatology, Pediatrics, Genetics·Medicare Advantage
Effective date
Sep 28, 2025
We identified it
Jun 25, 2026
Summary
Humana updated its Hyftor™ (sirolimus topical gel) prior authorization policy effective September 28, 2022, with a recent revision dated September 24, 2025. This is a maintenance update to the existing policy requiring prior authorization for Hyftor use in Medicare Advantage members with tuberous sclerosis complex (TSC) who have ≥3 facial angiofibromas and are not on systemic mTOR inhibitors. No billing codes are specified in this policy document.
Action Required
By September 28, 2025: Billing and prior authorization teams must verify this is the current Hyftor policy version in your system by checking Humana's online Medical and Pharmacy Coverage Policies portal at www.humana.com/PAL. If your practice bills Hyftor claims: (1) Confirm prior authorization workflows require documentation of TSC diagnosis, ≥3 facial angiofibromas, and confirmation patient is NOT on systemic mTOR inhibitors (everolimus); (2) Flag any Hyftor claims for patients under age 6 as non-covered (policy covers ages 6+); (3) Update prior auth templates to include dosage limits by age (600mg/day ages 6-11; 800mg/day ages 12+). Notify providers of contraindications: hypersensitivity to sirolimus, pregnancy/lactation, active infection, or interstitial lung disease symptoms. Do not use printed versions of this policy—reference only the online version. Failure to follow updated criteria may result in claim denials.