Medicare AdvantagePrior AuthLow impact
Cysteamine Ophthalmic Products (Cystaran®, Cystadrops®) (Revised)
Humana·Ophthalmology, Pharmacy·Medicare Advantage
Effective date
Aug 27, 2025
We identified it
Jun 25, 2026
Summary
Humana has revised its prior authorization policy for cysteamine ophthalmic products (Cystaran® and Cystadrops®) effective August 27, 2025. The policy maintains the requirement for prior authorization for Medicare Advantage members with cystinosis who are using these products to treat corneal cystine crystal accumulation. Approval is granted for the plan year duration or as determined through clinical review for both initial and renewal requests.
Action Required
By August 27, 2025: Billing team must ensure that all claims for Cystaran (0.44% in 15 mL bottles) and Cystadrops (0.37% in 5 mL bottles) for Medicare Advantage members include prior authorization documentation. Verify that members have a documented diagnosis of cystinosis and that the medication is being used for corneal cystine crystal accumulation treatment. Update any internal prior authorization tracking systems to reflect the revised policy date. No new denial patterns are expected, as this is a policy revision maintaining existing requirements. Providers should note updated storage and handling instructions (Cystaran: -25°C to -15°C frozen, thaw 24 hours, store at 2°C to 25°C for up to 1 week after thawing; Cystadrops: refrigerate unopened, room temperature once opened, discard after 1 week of use).