Medicare AdvantagePrior AuthMedium impact
Acitretin (Revised)
Humana·Dermatology, Pharmacy·Medicare Advantage
Effective date
Jul 23, 2025
We identified it
Jun 25, 2026
Summary
Humana updated its Medicare Advantage prior authorization policy for Acitretin (revised 7/23/2025). The policy maintains existing coverage criteria requiring diagnosis of severe cutaneous psoriasis AND prior treatment failure/contraindication/intolerance to methotrexate or cyclosporine. No changes to approval duration are specified in the revised document. Billing teams must ensure all Acitretin requests include documented evidence of both criteria before submission.
Action Required
By August 6, 2025: Billing and prior authorization teams must verify all Acitretin pharmacy requests include: (1) documented diagnosis of severe cutaneous psoriasis (plaque, guttate, erythrodermic, palmar-plantar, or pustular type), AND (2) evidence of prior treatment failure, contraindication, or documented intolerance to methotrexate OR cyclosporine. Update PA submission templates and checklist to reflect these two mandatory criteria. Providers must document these requirements on all new and renewal requests. Claims submitted without complete documentation of both criteria will be denied. Additionally, educate providers on critical safety requirements including: pregnancy prevention counseling (Do Your P.A.R.T. program), baseline and periodic fasting lipid panels, renal and hepatic function monitoring, and psychiatric monitoring for depression/suicidal ideation. Flag all female patients of childbearing age for mandatory pregnancy prevention education and reliable contraception verification prior to dispensing.