Medicare AdvantagePrior AuthMedium impact
Topical Rosacea Products (Revised)
Humana·Dermatology, Internal Medicine, Family Medicine·Medicare Advantage
Effective date
Jan 1, 2019
We identified it
Jul 28, 2026
Summary
This is a step therapy policy for topical rosacea products under Humana Medicare Advantage plans, requiring members to have prior treatment with topical metronidazole before coverage of other rosacea topicals (Finacea, Mirvaso, Rhofade, Soolantra, Epsolay, and their generics). The policy was revised July 23, 2026, and affects 14 topical rosacea products across multiple formulations.
Action Required
Effective immediately: Billing and prior authorization teams must implement step therapy requirement for all topical rosacea product claims on Humana Medicare Advantage plans. Before processing authorization requests for Finacea, Mirvaso, Rhofade, Soolantra, Epsolay, brimonidine, azelaic acid, oxymetazoline, or ivermectin topical formulations, verify member has documented prior treatment with topical metronidazole (Noritate, Metrogel, Rosadan). Update prior authorization workflows and denial messaging to reflect this step therapy requirement. Train billing staff to request clinical documentation of prior metronidazole use before submitting pharmacy claims. Claims submitted without evidence of step therapy completion will be denied. Note: Policy revision date of July 23, 2026 indicates recent updates—verify current version on Humana's website before processing claims.