Medicare AdvantagePrior AuthMedium impact
Oral Acne Antibiotics (Revised)
Humana·Dermatology·Medicare Advantage
Effective date
Jan 1, 2020
We identified it
Jun 25, 2026
Summary
This revised Humana Medicare Advantage policy establishes a Step Therapy requirement for oral acne antibiotics (minocycline extended-release formulations, Solodyn, Seysara, and Ximino). Members must have previous treatment or documented intolerance with generic immediate-release minocycline before extended-release formulations are covered. The policy was last revised on July 23, 2025 (1 day old) and is effective January 1, 2020.
Action Required
Immediately: Billing team must implement Step Therapy requirements in the claims system for all minocycline extended-release products (generic minocycline ER, Solodyn, Ximino, Seysara) for Humana Medicare Advantage members. Specifically: (1) Update authorization system to require documentation that member has tried generic immediate-release minocycline before approving extended-release formulations; (2) Add to prior authorization templates a requirement for providers to document previous treatment with or intolerance to immediate-release minocycline; (3) Train billing staff to request this documentation from providers before submitting claims for extended-release formulations; (4) Update claim denial messages to reference Step Therapy failure if documentation is missing. Failure to implement will result in claim denials and member complaints. Contact Humana PAL portal (www.humana.com/PAL) for preauthorization procedures.