Medicare AdvantagePrior AuthMedium impact
Acitretin (Revised)
Humana·Dermatology·Medicare Advantage
Effective date
Jan 1, 2021
We identified it
Jul 22, 2026
Summary
This is a revised Humana Medicare Advantage prior authorization policy for acitretin (a retinoid medication) used to treat severe psoriasis. The policy requires prior authorization and mandates that patients meet two criteria: diagnosis of severe cutaneous psoriasis AND previous treatment failure or contraindication to methotrexate or cyclosporine. The policy also includes critical safety warnings regarding teratogenicity, hepatic/renal contraindications, and psychiatric risks.
Action Required
By the next billing cycle: (1) Billing team must implement prior authorization requirement in billing system for all acitretin capsule prescriptions (10 mg, 17.5 mg, 25 mg strengths) for Medicare Advantage members. (2) Before submitting claims, verify that patient documentation includes: diagnosis of severe cutaneous psoriasis (plaque, guttate, erythrodermic, palmar-plantar, or pustular type) AND evidence of previous treatment/failure/contraindication/intolerance to methotrexate OR cyclosporine. (3) Update prior authorization submission forms to require these two criteria. (4) Flag prescriptions from providers not knowledgeable in systemic retinoid use and route to medical director review. (5) Add clinical alerts to EMR/billing system noting contraindications: pregnancy (3-year washout), severe hepatic dysfunction, severe renal impairment, chronic elevated blood lipids. (6) Communicate to providers that claims will be DENIED without prior authorization or if criteria are not met. Claims submitted without documentation of required prior treatment attempts will be rejected.