Medicare AdvantagePrior AuthMedium impact
Zyclara® (imiquimod) (Revised)
Humana·Dermatology, Urology·Medicare Advantage
Effective date
Jan 1, 2016
We identified it
Jun 25, 2026
Summary
Humana has revised its Zyclara (imiquimod) pharmacy coverage policy for Medicare Advantage plans, effective January 1, 2016, with the most recent revision dated October 22, 2025. The policy implements step therapy requiring members to have previous treatment or intolerance to generic imiquimod 5% cream before coverage of brand Zyclara is approved. This is a step therapy requirement that affects all formulations (2.5% and 3.75% cream in pump or packet form) used for actinic keratosis and external genital/perianal warts.
Action Required
By November 15, 2025: Billing and prior authorization teams must update their systems to enforce the step therapy requirement for all Zyclara (imiquimod) requests on Medicare Advantage plans. Specifically: (1) Update authorization templates to require documentation that the member has previously tried generic imiquimod 5% cream OR has documented intolerance to it before approving brand Zyclara; (2) Train prior auth reviewers that generic imiquimod must be the first-line therapy; (3) Update denial templates to cite the step therapy policy when rejecting Zyclara requests without prior generic trial; (4) Communicate this requirement to contracted dermatology and primary care providers. Failure to enforce step therapy will result in claim denials from Humana and potential member appeals. Note: The policy revision date of October 22, 2025 indicates this is a fresh update—verify against Humana's online portal before processing any Zyclara authorizations.