Medicare AdvantagePrior AuthMedium impact
Tolsura (itraconazole) (Revised)
Humana·Infectious Disease, Internal Medicine, Pulmonology·Medicare Advantage
Effective date
Oct 22, 2025
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its prior authorization policy for Tolsura (itraconazole) effective October 22, 2025. The policy maintains three covered indications (aspergillosis, blastomycosis, histoplasmosis) with specific criteria requiring failure or intolerance to alternative antifungals, excludes onychomycosis treatment, and approves coverage for 6-month periods with clinical review. Key safety warnings regarding CHF, hepatotoxicity, cardiac dysrhythmias, and extensive drug interactions with CYP3A4 and CYP2D6 metabolizers are emphasized.
Action Required
By October 22, 2025: Billing team must update prior authorization system to enforce Tolsura (itraconazole) coverage criteria. For aspergillosis claims, verify member has failed or is intolerant to amphotericin B AND at least one alternative (generic itraconazole, voriconazole, or posaconazole). For blastomycosis and histoplasmosis, verify diagnosis and prior trial/contraindication/intolerance to listed alternatives. Reject any claims for onychomycosis (automatic exclusion). Configure 6-month approval windows for both initial and renewal requests. Update provider templates and encounter forms to collect required documentation: diagnosis confirmation, prior antifungal therapy details, reasons for discontinuation (refractory/intolerant/contraindicated). Clinical team must screen all Tolsura PA requests for black box warnings: contraindicated drug interactions (see policy page 2 for full list including alfuzosin, midazolam, triazolam, lovastatin, simvastatin, methadone, etc.), hepatic/renal impairment status, and CHF history. Claims processed without proper PA or missing clinical criteria documentation will be denied.