Medicare AdvantagePrior AuthMedium impact
Cosopt® (dorzolamide and timolol ophthalmic solution) (Revised)
Humana·Ophthalmology, Optometry·Medicare Advantage
Effective date
Apr 22, 2026
We identified it
Jun 25, 2026
Summary
Humana revised its Cosopt (dorzolamide-timolol ophthalmic solution) coverage policy effective April 22, 2026. This is a step therapy policy for Medicare Advantage members requiring documentation of previous treatment or intolerance to dorzolamide/timolol before coverage is approved. The policy applies to all Cosopt formulations (brand name, preservative-free, and generic versions).
Action Required
Before April 22, 2026: Billing and prior authorization teams must update systems to enforce step therapy requirements for all Cosopt (dorzolamide-timolol) ophthalmic solution claims. Specifically: (1) Require documentation of prior treatment or intolerance to dorzolamide/timolol ophthalmic solution before approving new Cosopt prescriptions; (2) Apply this requirement to all affected products: Cosopt (PF) eye drops in dropperette, Cosopt eye drops, and generic dorzolamide-timolol (PF) eye drops in dropperette; (3) Update prior authorization templates and checklists to capture patient history of previous treatment attempts or documented adverse reactions; (4) Train authorization staff to request clinical documentation from prescribers when step therapy criteria are not met; (5) Configure claims system to deny coverage for initial and renewal Cosopt claims that do not include evidence of prior treatment/intolerance. Update provider bulletins to notify ophthalmologists and optometrists of this requirement. Failure to implement will result in claim denials and member coverage denials.