Medicare AdvantagePrior AuthMedium impact
Oral Isotretinoin Products (Revised)
Humana·Dermatology, Pharmacy·Medicare Advantage
Effective date
Jan 1, 2021
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage updated its step therapy policy for oral isotretinoin products (Absorica, Absorica LD) effective January 1, 2021, with a revision date of February 25, 2026. The policy requires members to have prior treatment with two of the following generic isotretinoin products (Amnesteem, Claravis, Isotretinoin, or Zenatane) before approval for Absorica or Absorica LD. This is a step therapy requirement that must be verified before pharmacy authorization.
Action Required
By February 25, 2026: Billing and pharmacy teams must verify that all prior authorization requests for Absorica capsule or Absorica LD capsule include documentation of prior treatment with at least two generic isotretinoin products (Amnesteem, Claravis, Isotretinoin, or Zenatane). Update pharmacy pre-authorization workflow in billing system to flag requests lacking this documentation. Communicate step therapy requirement to dermatology providers and their staff. Claims submitted without evidence of prior step therapy will be denied by Humana Medicare Advantage plans.