Medicare AdvantagePrior AuthMedium impact
Zilxi® (minocycline) Topical Foam (Revised)
Humana·Dermatology·Medicare Advantage
Effective date
Jul 23, 2025
We identified it
Jul 23, 2026
Summary
Humana Medicare Advantage has revised its prior authorization policy for Zilxi (minocycline) topical foam for rosacea treatment. The policy requires prior authorization and mandates that members must have documented previous treatment, intolerance, or contraindication with both topical metronidazole AND non-delayed release oral doxycycline before Zilxi can be approved. This is a recent policy (3 weeks old) that supersedes any older guidance on this drug.
Action Required
By July 23, 2025 (effective date): Billing team must implement prior authorization requirement for all Zilxi (minocycline) topical foam prescriptions for Medicare Advantage members. Update billing system to flag Zilxi claims and route to prior auth department. Providers must document in patient chart: (1) diagnosis of rosacea with inflammatory lesions, (2) previous treatment/intolerance/contraindication with topical metronidazole, AND (3) previous treatment/intolerance/contraindication with non-delayed release oral doxycycline (specify which formulation was used and reason for discontinuation). Front desk and clinical staff should add checklist to intake forms asking about prior rosacea treatments. Without prior authorization approval based on these three criteria, Medicare Advantage claims for Zilxi will be denied. Coordinate with providers to ensure proper documentation before claim submission.