Medicare AdvantagePrior AuthMedium impact
Clindagel® (clindamycin phosphate gel) (Revised)
Humana·Dermatology, Family Medicine, Internal Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2020
We identified it
Jun 25, 2026
Summary
Humana revised its prior authorization policy for Clindagel® (clindamycin phosphate gel) effective January 1, 2020, with the most recent revision dated October 22, 2025. The policy requires prior authorization for topical clindamycin gel treatment of acne vulgaris, with approval contingent on members meeting two criteria: diagnosis of acne vulgaris AND prior treatment or intolerance with at least two specified topical products (adapalene gel, generic clindamycin gel, or erythromycin solution). Approval duration extends for the plan year with renewal available.
Action Required
Immediately: Billing and prior authorization teams must implement the following for all Medicare Advantage claims involving Clindagel or generic clindamycin topical gel: (1) Flag all Clindagel prescriptions for prior authorization review before claim submission; (2) Require providers to document in the authorization request that the member has a confirmed diagnosis of acne vulgaris AND has received prior treatment or demonstrated intolerance to at least two of the following: adapalene gel, generic clindamycin gel (Cleocin-T formats), or erythromycin solution; (3) Update EMR templates and encounter forms to include a checklist for these two required criteria; (4) Configure billing system to hold Clindagel claims pending prior authorization approval to prevent denials. Train all front-desk and authorization staff on the new requirement. Claims submitted without documented evidence of both criteria will be denied. Verify current policy version at www.humana.com/PAL before processing each request.