Medicare AdvantagePrior AuthMedium impact
Panretin® (alitretinoin) (Revised)
Humana·Oncology, Infectious Disease, Pharmacy·Medicare Advantage
Effective date
Jan 1, 2022
We identified it
Jun 25, 2026
Summary
Humana revised its Panretin® (alitretinoin) prior authorization policy for Medicare Advantage effective January 1, 2022, with the most recent revision dated December 17, 2025. The policy maintains coverage for topical treatment of AIDS-related Kaposi's sarcoma cutaneous lesions only when systemic therapy is not required. Billing teams must ensure prior authorization is obtained before dispensing and verify member meets both eligibility criteria: confirmed AIDS-related Kaposi's sarcoma diagnosis and no requirement for systemic anti-KS therapy.
Action Required
Effective immediately: (1) Billing team must implement or verify prior authorization requirement for all Panretin (alitretinoin) 0.1% topical gel claims in the Medicare Advantage system. (2) Update pharmacy billing system to require documentation confirming member has AIDS-related Kaposi's sarcoma diagnosis AND that systemic therapy is not required before claim submission. (3) Front desk/prior auth staff must verify both clinical criteria are met using the policy's two-part approval criteria. (4) For medical-billed requests, staff should reference www.humana.com/PAL for current coding information. (5) Flag any claims indicating systemic anti-KS therapy (e.g., >10 new lesions in prior month, symptomatic lymphedema, pulmonary KS, or visceral involvement) as non-covered and deny with explanation. Failure to obtain prior authorization will result in claim denials. Note: Revision date of 12/17/2025 indicates recent policy updates—verify this is the current version on Humana's website before utilization.