Medicare AdvantagePrior AuthMedium impact
Ketoconazole tablet (Revised)
Humana·Infectious Disease, Transplant Surgery, Internal Medicine·Medicare Advantage
Effective date
Jan 1, 2021
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its ketoconazole tablet prior authorization policy effective January 1, 2021, with a recent revision date of April 22, 2026. The policy requires prior authorization for ketoconazole tablets used to treat systemic fungal infections (blastomycosis, coccidioidomycosis, histoplasmosis, paracoccidioidomycosis, chromomycosis) and for transplanted organ rejection prophylaxis when used concurrently with cyclosporine immunosuppressant therapy. Approval is granted in plan year durations or through clinical review, with emphasis on hepatotoxicity and QT prolongation warnings.
Action Required
Before submitting ketoconazole tablet claims to Humana Medicare Advantage: (1) Billing team must verify current policy version at www.humana.com/PAL and check the Medical and Pharmacy Coverage Policies portal for applicable preauthorization and notification lists and medical/procedural coding information; (2) For systemic fungal infection claims: confirm member diagnosis matches listed indications (blastomycosis, coccidioidomycosis, histoplasmosis, paracoccidioidomycosis, or chromomycosis) and obtain prior authorization before dispensing; (3) For transplant rejection prophylaxis claims: verify member has transplanted organ AND is concurrently receiving cyclosporine immunosuppressant therapy, then obtain prior authorization; (4) Update pharmacy billing system to flag all ketoconazole tablet requests as requiring prior authorization; (5) Educate prescribing providers and pharmacy staff that this is a high-risk medication with hepatotoxicity warnings and should only be used when other antifungal therapies are unavailable. Claims submitted without required prior authorization will be denied. Due to the April 22, 2026 revision date, immediately confirm this is the current policy version before implementation.