Currentculinary health fundPolicy N/A

Dermatology - Ycanth Utilization Management Medical Policy

Defines prior authorization recommended medical-benefit coverage criteria, dosing, duration, and exclusions for Ycanth (cantharidin 0.7% topical solution) for treatment of molluscum contagiosum in patients aged ≥2 years.

Policy Summary

Payerculinary health fund

PolicyDermatology - Ycanth Utilization Management Medical Policy

Policy CodePolicy N/A

Change TypeSelected revision (dosing); annual administrative reviews

Effective Date

Next Review Date

Key ActionPrior Authorization is recommended; approve for 3 months when criteria are met and document age, lesion history, and professional administration.

POLICY UPDATE CHANGES

Dosing was updated to approve up to two applicators per treatment, not more frequently than once every 21 days.

Annual revisions on 02/19/2025 and 02/18/2026 noted as 'No criteria changes.'

1Covered Indication

2Minimum age (years)

3Initial approval (months)

2Max applicators per treatment

Coverage Summary

Coverage stance: Covered with criteria. Scope: defines prior authorization–recommended medical-benefit coverage criteria, dosing, duration, and exclusions for Ycanth (cantharidin 0.7% topical solution) for treatment of molluscum contagiosum in patients aged ≥2 years. Indication summary: Ycanth is indicated for molluscum contagiosum in patients ≥2 years and is approved with specific clinical and administration criteria (provider documentation, treatment history limits, and dosing constraints).

Ycanth Key Thresholds

Minimum patient age>= 2 years

Prior Ycanth treatment limit< 4 treatment cycles

Dosing frequencyNot more frequently than once every 21 days

Maximum applicators per treatmentUp to two applicators per treatment

Initial approval duration3 months

Initial Therapy Criteria

FDA-Approved Indication - Molluscum Contagiosum (Initial Approval)

Approve Ycanth for 3 months if the patient meets ALL of the following (A, B, and C):

ALL of the following

Patient is ≥ 2 years of age>= 2 years
ONE of
- Patient is treating new lesions that have not previously been treated with Ycanth
- Patient is treating lesions that have been previously treated with Ycanth for less than 4 treatment cycles< 4 treatment cycles
Ycanth is being administered by a healthcare professional
Professional administration required

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FDA-Approved Indication - Molluscum Contagiosum (Initial Approval)

Continuation Therapy Criteria

Extended approvals: Allowed if the patient continues to meet the policy Criteria and the documented Dosing. Treatment cycle definition and continuation constraint: the policy defines a treatment cycle as an individual administered treatment occasion and limits continued eligibility to patients with prior Ycanth exposure of less than 4 treatment cycles. Dosing thresholds that apply to continuation include approval of up to two applicators per treatment, with treatments no more frequently than once every 21 days.

Provider Actions & Billing Requirements

Prior Authorization

Prior authorization recommended — approve for 3 months when criteria met

Prior authorization is recommended for medical benefit coverage of Ycanth. Approve for 3 months when the patient meets the policy criteria (age ≥2 years, lesion treatment history, and professional administration). Extended approvals may be granted if the patient continues to meet criteria; requests for doses outside established dosing will be reviewed case‑by‑case by a clinician.

Documentation Required

Document age and treatment history

Provider must document the following to support coverage:

Patient age: ≥ 2 years
Whether lesions are new (not previously treated with Ycanth) or previously treated with Ycanth for < 4 treatment cycles
Ycanth administration by a healthcare professional (professional administration)

Billing Rule

Dosing/billing frequency constraint

Dosing and billing constraints: approve up to two applicators per treatment, with treatments no more frequently than once every 21 days. Requests for doses outside the established dosing are considered on a case‑by‑case basis by a clinician.

Clinical Evidence

2Phase 3 trials

Day 84Primary endpoint: complete lesion clearance

Two phase 3 randomized clinical trials demonstrated efficacy for complete clearance at Day 84.

Ycanth™ topical solution prescribing information, Verrica, October 2024.

Background

Background: Ycanth (cantharidin 0.7% topical solution) is indicated for the treatment of molluscum contagiosum in patients aged ≥2 years. Molluscum contagiosum commonly resolves spontaneously within 6–12 months, though some cases may take longer and immunocompromised or atopic patients can have more extensive disease. Alternative treatment options supported in guidelines include cryotherapy, curettage, and cantharidin (compounded or Ycanth). Dosing context: a recent dosing update approved use of up to two applicators per treatment, administered no more frequently than once every 21 days.

Revision History

2025-03-12material_change

Dosing updated: approve up to two applicators per treatment, not more frequently than once every 21 days.

2025-02-19administrative_review

Annual Revision: No criteria changes.

2026-02-18administrative_reviewLatest