Medicare AdvantagePrior AuthMedium impact
Mupirocin Topical Cream (Revised)
Humana·Dermatology, Infectious Disease, Pediatrics +2 more·Medicare Advantage
Effective date
Jan 1, 2020
We identified it
Jun 25, 2026
Summary
This is a revision to Humana's Medicare Advantage step therapy policy for mupirocin 2% topical cream. The policy requires members to have previous treatment or documented intolerance with mupirocin topical ointment within the past 12 months before coverage of the cream formulation is approved. Coverage is approved for the plan year duration with renewal available.
Action Required
By December 31, 2025: Billing and prior authorization teams must implement step therapy requirement for all mupirocin topical cream (2%) claims on Medicare Advantage plans. Update authorization system to verify member has documented prior treatment or intolerance with mupirocin topical ointment within past 12 months before approving cream formulation. Communicate requirement to providers via prior auth submission guidelines. Update claim systems to deny requests that lack this clinical documentation. Reference the Humana PAL website (www.humana.com/PAL) for current medically billed request procedures. Ensure all authorizations reference the revision date of 11/26/2025.