CurrentMass General Brigham Health PlanPolicy N/A

Ycanth (cantharidin) prior authorization for molluscum contagiosum

Defines prior authorization requirements for coverage of Ycanth (cantharidin) under the medical benefit for MassHealth members age ≥2 years with molluscum contagiosum; applies to providers requesting Ycanth applicators.

Policy Summary

PayerMass General Brigham Health Plan

PolicyYcanth (cantharidin) prior authorization for molluscum contagiosum

Policy CodePolicy N/A

Change TypeRevised criteriaadministrative clarification

Effective DateOct 1, 2025

Next Review DateN/A

Key ActionObtain prior authorization and document diagnosis, age ≥2 years, prior treatment trial or contraindication to listed alternatives, and requested dose ≤8 applicators per 12 weeks.

SourceLink

POLICY UPDATE CHANGES

Updated criteria for Ycanth to include additional topical alternatives (potassium hydroxide, salicylic acid, topical retinoid) and added concomitant atopic dermatitis as an acceptable diagnosis.

Removed prescriber specialty requirement to match MassHealth policy.

≥2minimum eligible patient age

≤8maximum requested dose for approval

12 wksmaximum initial approval duration

MassHealth

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Coverage Criteria for Ycanth (cantharidin)

Initial Therapy

Covered when ALL of the following are met

Initial Authorization: Authorization may be granted when ALL of the following are met:

Diagnosis requirement: Diagnosis of molluscum contagiosum and ONE of: (a) itching, pain, or bleeding associated with lesions; (b) member is immunocompromised; (c) concomitant atopic dermatitis; (d) concomitant bacterial infection; (e) risk of spread to contacts (e.g., siblings, daycare).

Age requirement: Member is ≥2 years of age.>=2 years

Prior therapy requirement: Inadequate response or adverse reaction to ONE or contraindication to ALL of: (a) podofilox; (b) cryotherapy; (c) curettage; (d) potassium hydroxide; (e) salicylic acid; (f) topical retinoid (eg, adapalene, tazarotene, tretinoin).

Dose limit: Requested dose is ≤ 8 applicators per 12 weeks.<=8 applicators per 12 weeks

Continuation Therapy

Reauthorization requirements

Reauthorization is approved when the prescriber provides documentation of medical necessity for continued use beyond 12 weeks.

Initial approvals and reauthorizations will be granted for up to 12 weeks.

Initial authorizations for Ycanth (cantharidin) are limited to 12 weeks. Reauthorizations will also be granted in up to 12‑week intervals. No approvals will be issued beyond 12‑week intervals without prescriber documentation of medical necessity supporting continued use.

Dose, Age, and Quantity Limits

Maximum dose per authorization period

Maximum dose per authorization period≤ 8 applicators per 12 weeks

Authorization intervalApprovals granted for up to 12 weeks; dose limit applies within each 12-week authorization period

Exceeding limitRequests exceeding 8 applicators per 12 weeks may be denied without documentation of medical necessity

Minimum eligible age

Minimum eligible age≥ 2 years of age

Age supportYcanth is FDA‑approved for adults and children 2 years and older

Denial trigger

Provider Requirements and Prior Authorization

Prior Authorization

Prior authorization required for Ycanth (Medical Benefit — MassHealth)

Prior authorization is required for Ycanth (cantharidin) under the Medical Benefit for MassHealth members; approvals are granted only when all listed coverage criteria are met (diagnosis, age, prior therapies/contraindications, and dose limits).

Step Therapy

Prior treatment requirement — trial or contraindication to listed alternatives

Authorization requires documented inadequate response or adverse reaction to ONE, or contraindication to ALL, of the listed topical or procedural alternatives before Ycanth is approved.

podofilox
cryotherapy
curettage
potassium hydroxide
salicylic acid
topical retinoid (e.g., adapalene, tazarotene, tretinoin)

Clinical Background

Molluscum contagiosum is a common viral skin infection typically managed with topical agents or procedural removal. Ycanth (cantharidin) is an FDA‑approved topical treatment for molluscum contagiosum and is indicated for use in patients aged ≥ 2 years. It is applied to lesions to produce blistering and subsequent lesion resolution; prior authorization is required under the medical benefit when coverage criteria are met.

Definitions

Ycanth (cantharidin) — Definition and indication (FDA-approved for age ≥2 years)

DrugYcanth (cantharidin)

DefinitionCantharidin topical formulation marketed as Ycanth; first FDA‑approved treatment for molluscum contagiosum

IndicationTreatment of molluscum contagiosum in adults and children aged ≥2 years

Relevant clinical noteUsed when diagnosis of molluscum contagiosum meets coverage criteria (see authorization requirements)