Medicare AdvantagePrior AuthMedium impact
Topical Antifungals (Revised)
Humana·Dermatology, Family Medicine, Internal Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2020
We identified it
Jul 23, 2026
Summary
This is a Step Therapy policy for topical antifungal medications (Exelderm, Luzu, Naftin, and sulconazole products) that requires members to have failed or be intolerant to two first-line topical antifungals (clotrimazole, ciclopirox, or ketoconazole) within the past 12 months before coverage is approved. The policy was revised on July 22, 2026, establishing the current authorization criteria for these medications.
Action Required
Immediately: Billing and prior authorization teams must implement step therapy requirements for all topical antifungal prescriptions (naftifine, luliconazole, sulconazole, and brand names Naftin, Luzu, Exelderm) for Medicare Advantage members. Before submitting claims or authorizations: (1) Verify in member records that patient has documented prior treatment within past 12 months with at least TWO of the following: clotrimazole cream, ciclopirox 0.77% cream/gel/suspension, or ketoconazole cream, OR has documented contraindication/intolerance to two of these agents; (2) Update prior authorization request forms to capture this step therapy requirement; (3) Train billing staff to request this documentation from providers before processing requests; (4) Communicate with in-house providers and external referrals about the step therapy criteria. Claims for these topical antifungals submitted without evidence of step therapy completion will be denied.