Medicare AdvantagePrior AuthMedium impact
Tazorac® (tazarotene cream and gel) (Revised)
Humana·Dermatology·Medicare Advantage
Effective date
Jan 1, 2021
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its prior authorization policy for Tazorac (tazarotene cream and gel) effective January 1, 2021, with the most recent revision dated February 25, 2026. The policy requires prior authorization for both plaque psoriasis and acne vulgaris indications, with specific clinical criteria and exclusions for cosmetic uses. Billing teams must verify all Tazorac claims meet documented diagnosis requirements and prior treatment/intolerance criteria before submission to avoid denials.
Action Required
By March 15, 2026: Billing and clinical teams must implement the following for all Tazorac (tazarotene cream/gel) claims submitted to Humana Medicare Advantage: (1) Verify patient diagnosis is documented as either stable plaque psoriasis OR acne vulgaris in the medical record before claim submission; (2) For psoriasis cases: confirm prior authorization request includes documentation of previous treatment, intolerance, or contraindication with topical betamethasone dipropionate or triamcinolone 0.5%; (3) For acne cases: confirm prior authorization request includes documentation of previous treatment or intolerance to generic topical tretinoin (non-micro); (4) Reject any claims for cosmetic indications (solar lentigines, wrinkles, skin roughness) without an approvable medical indication; (5) Update encounter templates and prior auth submission forms to include these clinical criteria checkboxes. Assign responsibility to Prior Authorization Coordinator and Billing Supervisor. Document all supporting evidence in the patient chart before submitting to Humana. Failure to obtain proper prior authorization will result in claim denials.