Medicare AdvantagePrior AuthMedium impact
Topical Psoriasis Agents (Revised)
Humana·Dermatology, Pharmacy·Medicare Advantage
Effective date
Jan 1, 2021
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its Topical Psoriasis Agents pharmacy coverage policy (effective 1/1/2021, revised 10/22/2025) implementing a step therapy requirement. Members must have prior treatment with at least two generic topical corticosteroids (triamcinolone, mometasol, fluticasone, betamethasone, or clobetasol) before coverage approval for branded topical psoriasis agents including Clobex, Bryhali, Luxiq, Cordran, Sorilux, Vectical, and calcipotriene formulations.
Action Required
Immediately: Billing and pharmacy teams must implement step therapy verification for all topical psoriasis agent requests. Before submitting claims or prior authorization requests for Clobex lotion/shampoo/spray, Sorilux, Vectical, calcitriol ointment, Luxiq, Bryhali, Cordran (all formulations), amcinonide, or calcipotriene: (1) Verify member has documented prior treatment with at least TWO of the following generic products: triamcinolone, mometasone, fluticasone, betamethasone, or clobetasol; (2) Obtain prior authorization from Humana Medicare Advantage plans demonstrating this requirement is met; (3) Update pharmacy workflow systems and provider order entry systems to flag and require documentation of prior generic corticosteroid use before processing these medications. Document the specific generic agents used and dates of treatment in the member's record. Claims submitted without evidence of prior step therapy will be denied by Humana Medicare Advantage.