CommercialPrior AuthMedium impact
Otic Antibiotics (Revised)
Humana·ENT (Ear, Nose & Throat), Family Medicine, General Practice +1 more·Commercial
Effective date
Feb 28, 2024
We identified it
Jun 25, 2026
Summary
Humana revised its Otic Antibiotics step therapy policy (effective 2/28/2024) for commercial plans covering Cetraxal, Cipro HC, Ciprodex, and Otovel. The policy requires members to have documented trial, intolerance, or contraindication to TWO of three first-line otic antibiotics (ciprofloxacin ear drops, ofloxacin ear drops, or neomycin-polymyxin-HC otic solution) before approval of branded otic antibiotic combinations. This is a step therapy requirement that must be met for coverage.
Action Required
By March 31, 2024: Billing team must implement prior authorization workflow changes for all otic antibiotic requests on Humana commercial plans. (1) Update billing system to flag all Cetraxal, Cipro HC, Ciprodex, and Otovel claims requiring step therapy verification. (2) Create or update prior authorization templates to capture evidence that member has had trial/intolerance/contraindication to TWO of the following: ciprofloxacin ear drops, ofloxacin ear drops, or neomycin-polymyxin-HC otic solution within past 12 months. (3) Train billing and clinical staff that claims lacking this documentation will be denied. (4) Providers must document first-line therapy attempts on encounter notes before prescribing branded combinations. Ensure authorization is obtained before dispensing to avoid claim denials and patient out-of-pocket costs.