Medicare AdvantagePrior AuthMedium impact
Zoryve (roflumilast) (Revised)
Humana·Dermatology, Pediatrics·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jul 23, 2026
Summary
Humana has revised its Zoryve (roflumilast) prior authorization policy effective January 1, 2026, with updates as of July 22, 2026. This pharmacy coverage policy establishes prior authorization requirements for Zoryve topical cream and foam across three indications: plaque psoriasis, atopic dermatitis, and seborrheic dermatitis. The policy requires specific diagnostic criteria and documentation of previous treatment failures or contraindications with established therapies before Zoryve can be approved.
Action Required
By January 1, 2026: Billing team must implement prior authorization requirements for all Zoryve (roflumilast) prescriptions in the billing system. Update authorizations workflow to verify: (1) For plaque psoriasis—confirm diagnosis, BSA ≥2% with prior treatment/contraindication/intolerance to BOTH topical corticosteroid AND vitamin D product, OR prescriber documentation that psoriasis affects sensitive areas; (2) For atopic dermatitis—confirm mild-to-moderate diagnosis and prior treatment/intolerance/contraindication to topical corticosteroids OR calcineurin inhibitors (exception: children <2 years do not require calcineurin inhibitor history); (3) For seborrheic dermatitis—confirm diagnosis and prior treatment/contraindication/intolerance to BOTH topical corticosteroid AND topical antifungal (exception: children <12 years do not require antifungal history). Train providers and prior authorization staff on these criteria. Flag all Zoryve requests for manual review before submission. Obtain prior authorization approval before claims processing. Denials will result if prior authorization is not obtained or criteria are not met. Reference Humana's PAL (Preauthorization and Notification List) at www.humana.com/PAL for claim code requirements.