CurrentCentenePolicy HIM.PA.134

Spinosad (Natroba) topical suspension — Coverage Criteria for Head Lice and Scabies

Policy governing prior authorization and coverage criteria for topical spinosad (Natroba) for head lice and scabies treatment for members of Centene-affiliated health plans.

Policy Summary

PayerCentene

PolicySpinosad (Natroba) topical suspension — Coverage Criteria for Head Lice and Scabies

Policy CodePolicy HIM.PA.134

Change TypeAdded step therapy bypass for Illinois

Effective DateDec 1, 2017

Next Review Date

Key ActionSubmit prior authorization with supporting clinical documentation showing diagnosis, age, and failure of permethrin (unless contraindicated).

SourceLink

POLICY UPDATE CHANGES

Added step therapy bypass for Illinois HIM per IL HB 5395.

2FDA-approved indications included

120 mLbottle size

14 daysinitial approval duration (head lice)

Not permittedRe-authorization

Coverage Criteria

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Initial Therapy — Head Lice

Covered when ALL of the following are met for Head Lice:

Head Lice initial approval: 1) Diagnosis of head lice; 2) Failure of permethrin 1% cream in the last 60 days unless contraindicated or clinically significant adverse effects are experienced; 3) Age criteria met per product labeling; 4) Request does not exceed both of the following: a) 2 bottles and b) (secondary limit as specified in policy). Approval duration: 14 days.Up to 120 mL per application

Illinois HIM requests are exempt from the step therapy requirement per IL HB 5395 effective 1/1/2026.

Initial Therapy — Scabies

Covered when ALL of the following are met for Scabies Infestation:

Scabies initial approval: 1) Diagnosis of scabies infestation; 2) Age ≥ 4 years; 3) Failure of permethrin 5% cream unless contraindicated or clinically significant adverse effects are experienced; 4) Request does not exceed both of the following: a) 4 bottles and b) 16 oz.

Illinois HIM requests are exempt from the step therapy requirement per IL HB 5395 effective 1/1/2026.

Other Indications

Other diagnoses/indications (non-standard):

Other uses: 1) For drugs on the formulary or PDL: follow the no-coverage criteria policy for the applicable line of business (e.g., HIM.PA.33 for health insurance marketplace or applicable policy). 2) For drugs not on the formulary or PDL: follow the non‑formulary policy for the applicable line of business (e.g., HIM.PA.103). 3) If the requested use is not specifically listed in the 'Diagnoses/Indications for which coverage is NOT authorized' section and criterion 1–2 do not apply, refer to the off‑label use policy for the applicable line of business (e.g., HIM.PA.154).

If the drug underwent a label change within the last 6 months not reflected in this policy, follow the referenced policies or updated labeling.

Coverage for indications that are not FDA-approved is not authorized under this policy unless the provider submits sufficient clinical documentation demonstrating efficacy and safety in accordance with the plan's off‑label use requirements. Providers should follow the referenced off‑label use policy HIM.PA.154 (or applicable evidence of coverage documents for the member's line of business) when requesting coverage for non‑FDA indications.

Re‑authorization for continued therapy is not permitted. Continued treatment requests will not be approved unless the request meets the original initial approval criteria. Providers must submit documentation demonstrating that the member fulfils the initial approval requirements for the applicable indication each time coverage is requested.

Provider Actions and Requirements

Prior Authorization

Prior Authorization Required

Prior authorization is required and will be approved when initial approval criteria for head lice or scabies are met. Requests for Illinois Health Insurance Marketplace (HIM) members are subject to the Illinois step therapy bypass (see Step Therapy note).

Prior authorization required when criteria met
Approval duration: 14 days

Step Therapy

Step Therapy and IL Bypass

Step therapy: Members must have a documented failure of topical permethrin (1% for head lice; 5% for scabies) within the specified prior time frame unless permethrin is contraindicated or causes clinically significant adverse effects. Illinois HIM bypass: For Illinois HIM requests, step therapy requirements do not apply as of 01/01/2026 per IL HB 5395.

Head lice: failure of permethrin 1% cream in the last 60 days unless contraindicated
Scabies: failure of permethrin 5% cream unless contraindicated
Illinois HIM: step therapy bypass effective 01/01/2026 (IL HB 5395)

Documentation Required

Documentation & Supporting Evidence Required

Provider must submit documentation supporting that the member has met all approval criteria. Acceptable supporting documentation includes office chart notes, lab results, or other clinical information. Failure to submit adequate supporting documentation may result in denial of the request. Requests for non–FDA-approved indications require sufficient documentation of efficacy and safety per the off‑label use policy (see HIM.PA.154) and may impact authorization decisions.

Acceptable documentation: office chart notes, lab results, or other clinical information
Non‑FDA indications: must follow off‑label use policy HIM.PA.154 and provide sufficient evidence of efficacy and safety
Insufficient documentation may result in denial

OpenPayer

Spinosad (Natroba) topical suspension — Coverage Criteria for Head Lice and Scabies

Coverage Criteria

Coding and Product Details

Provider Actions and Requirements

Background

Definitions