Medicare AdvantagePrior AuthMedium impact
Mupirocin Topical Cream (Revised)
Humana·Dermatology, Infectious Disease, Pediatrics +2 more·Medicare Advantage
Effective date
Jan 1, 2020
We identified it
Jul 22, 2026
Summary
This is a Step Therapy policy for Mupirocin Topical Cream (2% cream formulation) under Medicare Advantage, requiring members to have previous treatment with mupirocin topical ointment within the past 12 months OR documented intolerance before cream approval. The policy was revised on July 22, 2026 (2 weeks old) and establishes coverage criteria for impetigo and other skin/soft tissue infections caused by susceptible Staphylococcus aureus or Streptococcus pyogenes.
Action Required
By August 30, 2026: Billing and authorization teams must implement Step Therapy screening for all mupirocin topical cream (2%) requests on Medicare Advantage plans. Before processing claims or submitting prior authorization requests, verify that the member has documented evidence of: (1) prior treatment with mupirocin topical ointment within the past 12 months, OR (2) documented intolerance to mupirocin topical ointment. Update prior auth submission templates and internal authorization software to require this Step Therapy criterion. Train authorization staff to request clinical documentation from providers if criteria are not met on initial submission. Claims submitted without evidence of prior ointment treatment or documented intolerance will be denied as not meeting medical necessity requirements.