Medicare AdvantagePrior AuthMedium impact
Zelsuvmi™ (berdazimer) (Revised)
Humana·Dermatology, Pediatrics, Pharmacy·Medicare Advantage
Effective date
Aug 27, 2025
We identified it
Sep 2, 2026
Summary
Humana Medicare Advantage has established a new prior authorization policy for Zelsuvmi (berdazimer) topical gel for molluscum contagiosum treatment. Coverage requires documentation that the patient has a confirmed molluscum contagiosum diagnosis AND has failed, been contraindicated, or intolerant to conventional therapies (podofilox, cimetidine, or imiquimod). All Zelsuvmi prescriptions now require prior authorization before dispensing.
Action Required
Effective immediately (August 27, 2025): (1) Billing and pharmacy staff must implement prior authorization requirement for all Zelsuvmi (berdazimer) topical gel prescriptions for Medicare Advantage members. (2) Update billing system/pharmacy software to flag Zelsuvmi claims for mandatory prior auth submission before dispensing. (3) Providers must document on prescription: (a) confirmed molluscum contagiosum diagnosis, and (b) evidence of previous treatment failure, contraindication, or intolerance with at least one conventional therapy (podofilox, cimetidine, or imiquimod). (4) Prior auth requests must include this documentation or claims will be denied. (5) Educate prescribers and front desk staff that Zelsuvmi requires prior authorization—claims submitted without prior auth approval will be denied. (6) Verify current policy status on Humana's online system before processing each claim, as printed copies become uncontrolled.