Medicare AdvantagePrior AuthMedium impact
Doxycycline Antibiotics (Revised)
Humana·Infectious Disease, Dermatology, Family Medicine +2 more·Medicare Advantage
Effective date
Jan 1, 2021
We identified it
Jul 22, 2026
Summary
This is a step therapy policy for doxycycline antibiotics under Medicare Advantage that requires members to have prior treatment or documented intolerance with oral immediate-release doxycycline before approval for brand-name or delayed-release formulations. The policy, revised July 22, 2026, applies to multiple doxycycline products including Doryx, Oracea, Avidoxy, and generics used for infections, acne, and rosacea.
Action Required
Immediately: Billing and prior authorization teams must implement step therapy screening for all doxycycline antibiotic claims on Medicare Advantage plans. Before submitting claims for brand-name or delayed-release doxycycline products (Doryx, Doryx MPC, Oracea, Avidoxy, Acticlate, Mondoxyne NL, Monodox, Morgidox, Targadox, doxycycline hyclate DR, doxycycline IR-DR), verify in the patient record that the member has either: (1) received prior treatment with immediate-release doxycycline (50mg, 75mg, or 100mg capsule/tablet), OR (2) documented intolerance/adverse reaction to immediate-release formulation. Update EMR templates and billing system rules to flag these products for manual review or automated prior authorization submission to Humana with documentation of step therapy criteria. Claims submitted without evidence of step therapy completion will be denied. Pharmacy staff should counsel patients on this requirement and work with providers to document prior treatment history.