Medicare AdvantagePrior AuthMedium impact
Topical Rosacea Products (Revised)
Humana·Dermatology, Family Medicine, Internal Medicine·Medicare Advantage
Effective date
Jan 1, 2019
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage revised its Step Therapy policy for topical rosacea products effective January 1, 2019, with the most recent revision dated December 17, 2025. The policy requires members to have prior treatment with topical metronidazole before coverage of other topical rosacea agents (Noritate, Metrogel, Rosadan, Finacea, Mirvaso, Soolantra, Rhofade, Epsolay, and their generic equivalents). Billing teams must enforce this step therapy requirement by obtaining documentation of metronidazole trial before approving claims for alternative topical rosacea products.
Action Required
Immediately: Billing and prior authorization teams must update their systems to enforce step therapy requirements for all topical rosacea products listed in this policy (Noritate, Metrogel, Rosadan cream/gel, Finacea foam/gel, Mirvaso, Soolantra, Rhofade, Epsolay, and generic equivalents). Before submitting claims or processing prior authorizations for any of these products on Medicare Advantage plans, verify that the member has documented prior treatment with topical metronidazole (metronidazole 0.75% cream/gel/lotion or Noritate/Metrogel/Rosadan products). Add this verification requirement to all PA request forms and billing software validation rules. Claims submitted without evidence of metronidazole trial will be denied. Communicate this step therapy requirement to all providers prescribing these medications, particularly dermatologists and primary care physicians managing rosacea cases. Update encounter documentation templates to capture metronidazole trial history.