Medicare AdvantagePrior AuthMedium impact
Oral Acne Antibiotics (Revised)
Humana·Dermatology, Pediatrics, Internal Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2020
We identified it
Jul 22, 2026
Summary
This is a Step Therapy policy for oral acne antibiotics (minocycline extended-release formulations, Solodyn, Seysara, and Ximino) under Medicare Advantage. Members must have previous treatment or documented intolerance with generic immediate-release minocycline before authorization for extended-release formulations. The policy was revised on July 22, 2026, with no changes to the core step therapy requirement.
Action Required
Before submitting claims for minocycline ER, Solodyn, Seysara, or Ximino: (1) Billing team must verify member has documentation of prior treatment with generic immediate-release minocycline OR documented intolerance to it in the medical record. (2) Obtain prior authorization from Humana Medicare Advantage before dispensing/billing. (3) Update claim submission process to include step therapy verification checklist. (4) Train front desk and clinical staff to collect prior medication history during intake. (5) Reference www.humana.com/PAL for specific preauthorization procedures and notification requirements. Claims submitted without evidence of step therapy completion will be denied.