Bexarotene products (Targretin capsules and gel, bexarotene capsules and gel) (Revised)

REQUIREMENTS: - Immediately: Billing and pharmacy teams must verify that all bexarotene product claims (Targretin capsule, Targretin topical gel, generic bexarotene capsule, generic bexarotene topical gel) are routed through the prior authorization process before submission to Humana Medicare Advantage plans. - Before dispensing any bexarotene prescription: Verify the member meets clinical criteria (primary treatment OR prior failed/intolerant systemic CTCL therapy for capsules; OR prior failed/intolerant CTCL therapy for topical gel) and is not pregnant. - Update pharmacy system to flag all bexarotene products with requirement for prior auth; ensure PA request includes documented evidence of prior CTCL therapy failure, intolerance, or contraindication (for capsules) or prior CTCL therapy failure/intolerance (for topical gel). - Providers must document medical necessity and patient's prior treatment history in PA submission; no more than one month supply of bexarotene capsules should be dispensed due to pregnancy testing requirements. - Reference www.humana.com/PAL for specific medical billing claim codes and PA submission procedures. - Consequence: Claims submitted without prior authorization will be denied by Humana Medicare Advantage plans.