Medicare AdvantagePrior AuthMedium impact
Bexarotene products (Targretin capsules and gel, bexarotene capsules and gel) (Revised)
Humana·Oncology, Dermatology·Medicare Advantage
Effective date
Jan 1, 2021
We identified it
Aug 12, 2026
Summary
This is a revised Humana Medicare Advantage prior authorization policy for bexarotene products (Targretin and generic bexarotene capsules and topical gel) effective January 1, 2021, with a revision date of July 22, 2026. The policy requires prior authorization for bexarotene use in cutaneous T-cell lymphoma (CTCL), with specific criteria for systemic vs. topical formulations and mandatory exclusion for pregnant members. The revision reflects updated guidance on approval duration and documentation requirements.
Action Required
By August 5, 2026 (before implementation): (1) Billing team must update prior authorization system to flag all bexarotene and Targretin prescriptions for Medicare Advantage members requiring PA submission. (2) Create or update PA request templates to capture: (a) confirmation that member is using bexarotene as primary treatment OR has documented disease progression/intolerance/contraindication to at least one prior systemic therapy (for capsules) or at least one prior CTCL therapy (for topical gel), and (b) verification that member is NOT pregnant. (3) Front desk/authorization staff must verify pregnancy status documentation before approving any bexarotene capsule prescriptions, given Black Box warning for FDA pregnancy category X. (4) Providers must be notified that only one-month supplies of bexarotene capsules will be approved per policy requirement for pregnancy testing intervals. (5) All claims for bexarotene products submitted without documented prior authorization will be denied by Humana.