Medicare AdvantagePrior AuthMedium impact
Doxycycline Antibiotics (Revised)
Humana·Dermatology, Infectious Disease, Internal Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2021
We identified it
Jun 25, 2026
Summary
This is a Step Therapy policy revision for doxycycline antibiotics (effective 1/1/2021, revised 7/23/2025) on Humana Medicare Advantage plans. The policy requires members to have previous treatment or documented intolerance with oral immediate-release doxycycline before coverage of delayed-release or brand formulations. Billing teams must verify step therapy compliance before submitting claims for affected doxycycline products to avoid denials.
Action Required
By August 6, 2025 (within 2 weeks of revision date): Billing and prior authorization teams must update workflows to enforce the step therapy requirement for all doxycycline claims on Humana Medicare Advantage plans. Before processing any claim for delayed-release formulations (Doryx, Doryx MPC, doxycycline hyclate delayed-release, Acticlate, Mondoxyne NL, Monodox, Morgidox, Oracea, Targadox, Avidoxy), verify in the member's treatment history that they have: (1) previously received oral immediate-release doxycycline (monohydrate 50mg, 75mg, 100mg capsule/tablet, or hyclate equivalents), OR (2) documented intolerance/adverse reaction to immediate-release formulations. Update prior authorization request templates and denial letter language to reference this step therapy requirement. Instruct clinical staff and providers to obtain treatment history documentation from patient records or prior authorizations before submission. Failure to verify step therapy compliance will result in Humana claim denials.