Medicare AdvantagePrior AuthLow impact
Bexarotene products (Targretin capsules and gel, bexarotene capsules and gel) (Revised)
Humana·Oncology·Medicare Advantage
Effective date
Jan 1, 2021
We identified it
Jul 22, 2026
Summary
This is a revised Medicare Advantage prior authorization policy for bexarotene products (Targretin and generic bexarotene) used to treat cutaneous T-cell lymphoma (CTCL). The policy requires prior auth for both oral capsules and topical gel formulations, with approval contingent on disease progression/intolerance to prior therapy or primary treatment use. Pregnancy is an absolute exclusion due to black box warning (FDA Category X).
Action Required
Before submitting claims for bexarotene products to Humana Medicare Advantage: (1) Billing team must verify current policy version at www.humana.com/PAL before processing each request, as Humana updates policies regularly; (2) Ensure prior authorization is obtained before claim submission—this is required for all bexarotene formulations (capsules and topical gel); (3) Documentation must confirm either: (a) bexarotene as primary treatment, OR (b) disease progression/intolerance/contraindication to at least one prior systemic therapy for CTCL (for capsules) or at least one prior CTCL therapy (for topical gel); (4) Verify member is not pregnant (exclusion applies to all formulations); (5) For capsule prescriptions, confirm one-month supply limit and pregnancy test results are addressed per prescribing guidelines. Claims submitted without prior authorization will be denied.