CurrentUnitedHealthcarePolicy N/A

Step Therapy — Topical Corticosteroids Coverage Criteria

Defines prior authorization step therapy requirements for coverage of specified topical steroid products for UnitedHealthcare members; affects prescribers and pharmacies submitting PA requests for listed topical corticosteroids.

Policy Summary

PayerUnitedHealthcare

PolicyStep Therapy — Topical Corticosteroids Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2026

Next Review DateOct 1, 2025

Key ActionObtain prior authorization with documented trial and failure, contraindication, or intolerance to required step 1 (and where applicable step 2) topical steroid agents per potency class; authorizations are issued for 12 months.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1/1/2026policy effective date

Step 1 → Step 2required sequencing

12 moauth duration

2014–2025P&T reviews

Coverage Criteria

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Step therapy coverage criteria by potency class

Covered when the specified step therapy trial requirements for the potency class are met:

Lower-mid potency (Class 5 and 6) - Step 1 failure

Lower-mid (Class 5 and 6) Step 1 agents: hydrocortisone butyrate 0.1% ointment; hydrocortisone valerate 0.2% cream; prednicarbate 0.1% ointment; triamcinolone acetonide 0.1% lotion; triamcinolone acetonide 0.025% ointment; fluticasone propionate cream 0.05%

Lower-mid potency (Class 5 and 6) - Step 2 requirement

Lower-mid (Class 5 and 6) Step 2 agents: flurandrenolide 0.05% lotion; desonide 0.05% gel; fluticasone propionate 0.05% lotion

Medium (Class 4) requirements

Medium (Class 4) Step 1 agents: mometasone furoate cream 0.1%; fluocinolone acetonide 0.025% ointment (generic Synalar)
Medium (Class 4) Step 2 agents: Cloderm cream (clocortolone pivalate 0.1%); flurandrenolide 0.05% ointment
Cloderm (brand) is excluded for most benefits

Potent (Class 2) requirements

Potent (Class 2) Step 1 agents: betamethasone dipropionate propylene glycol 0.05% cream; fluocinonide 0.05% cream; fluocinonide 0.05% ointment
Potent (Class 2) Step 2 agents: Halog cream (halcinonide 0.1%); Bryhali (halobetasol propionate 0.01% lotion)
Halog, Bryhali brands excluded for most benefits

Super Potent (Class 1) requirements

Super Potent (Class 1) Step 1 agents: augmented betamethasone dipropionate 0.05% gel or lotion; clobetasol propionate 0.05% gel or solution
Super Potent (Class 1) Step 2 agents: Ultravate (halobetasol propionate 0.05% lotion)
Ultravate brand excluded for most benefits

Initial Therapy Requirements

Initial therapy step requirements

Initial coverage requires step therapy trials

Lower-mid (Class 5 and 6) Step 1 agents: hydrocortisone butyrate 0.1% ointment; hydrocortisone valerate 0.2% cream; prednicarbate 0.1% ointment; triamcinolone acetonide 0.1% lotion; triamcinolone acetonide 0.025% ointment; fluticasone propionate cream 0.05%trial and failure of two agents when seeking step 2

Lower-mid (Class 5 and 6) Step 2 agents: flurandrenolide 0.05% lotion; desonide 0.05% gel; fluticasone propionate 0.05% lotion

Medium (Class 4) agents: mometasone furoate cream 0.1%; Cloderm cream (clocortolone pivalate 0.1%); fluocinolone acetonide 0.025% ointment; flurandrenolide 0.05% ointment

Cloderm brand excluded for most benefits

Potent (Class 2) agents: betamethasone dipropionate propylene glycol 0.05% cream; fluocinonide 0.05% cream; Halog cream (halcinonide 0.1%); Bryhali (halobetasol propionate 0.01% lotion)

Halog and Bryhali brands excluded for most benefits

Super Potent (Class 1) agents: augmented betamethasone dipropionate 0.05% gel or lotion; clobetasol propionate 0.05% gel or solution; Ultravate (halobetasol propionate 0.05% lotion)trial of both step 1 agents required

Ultravate brand excluded for most benefits

Step Therapy Table

Potency class	Required step(s) before coverage	Step 1 (required agents)	Step 2 (required agents, where applicable)
Lower‑mid (Class 5 and 6)	Failure, contraindication, or intolerance to two Step 1 medications	hydrocortisone butyrate 0.1% ointment; hydrocortisone valerate 0.2% cream; prednicarbate 0.1% ointment; triamcinolone acetonide 0.1% lotion; triamcinolone acetonide 0.025% ointment; fluticasone propionate cream 0.05%	flurandrenolide 0.05% lotion; desonide 0.05% gel; fluticasone propionate 0.05% lotion
Medium (Class 4)	Failure, contraindication, or intolerance to the Step 1 medications (and Step 2 where listed) per medium potency listing	mometasone furoate cream 0.1%; fluocinolone acetonide 0.025% ointment (generic Synalar)	Cloderm cream (clocortolone pivalate 0.1%); flurandrenolide 0.05% ointment
Potent (Class 2)	Failure, contraindication, or intolerance to the Step 1 medications (and Step 2 where listed) per potent potency listing	betamethasone dipropionate propylene glycol 0.05% cream; fluocinonide 0.05% cream; (also fluocinonide 0.05% ointment noted)	Halog cream (halcinonide 0.1%); Bryhali (halobetasol propionate 0.01% lotion)
Super Potent (Class 1)	Failure, contraindication, or intolerance to both Step 1 superpotent medications prior to coverage of Step 2 agents	augmented betamethasone dipropionate 0.05% gel or lotion; clobetasol propionate 0.05% gel or solution	Ultravate (halobetasol propionate 0.05% lotion)

Provider Actions and Documentation Requirements

Denial Risk

Prior therapy missing

Prior authorization is required when prior therapy documentation is missing. Requests that do not include adequate prior medication history, documentation of contraindication, or evidence of intolerance may be denied or returned for more information. Submit complete prior therapy records to avoid delays.

Missing documentation may result in denial or return for additional information
Include dates, medications tried, doses, and reasons for failure/intolerance when available

Documentation Required

Evidence required

Evidence supporting the prior authorization request must be provided. UnitedHealthcare may require prior medication history, relevant ICD-10 diagnosis codes, and claim history. Automated approvals may be granted when this data is available in claims, but submission of documentation with the request expedites review.

Provide prior medication history (drug names, dates, doses, response)
Include ICD-10 diagnosis codes relevant to the condition
Attach claim history or pharmacy fill records when possible

Step Therapy

Step therapy sequencing

Step therapy sequencing must be followed. Coverage requires documented history of failure, contraindication, or intolerance to required lower-step agents before approval of higher-step or superpotent agents. Trial requirements vary by potency class (step 1, step 2, medium, potent, superpotent).

Must trial lower-mid (Class 5–6) Step 1 agents before higher classes
Document failure/contraindication/intolerance to the specified number and potency of agents (see policy coverage criteria)

Note

Operational notes and authorization period

When required documentation is not supplied, UnitedHealthcare may approve initial or re-authorization based on available claims, medication history, and ICD-10 diagnosis codes. Supply limits may apply; authorization, when granted, is typically issued for 12 months. Brand products listed in the policy may be excluded for many benefit plans.

Authorizations are generally valid for 12 months
State mandates and member benefit plans may affect coverage
Some branded topical steroids (Cloderm, Synalar, Halog, Ultravate, Bryhali) are excluded from coverage for many benefits

Background

Topical corticosteroids are anti-inflammatory agents commonly used to treat conditions such as rash, eczema, and dermatitis. They are classified by clinical potency using vasoconstriction bioassays, with potency classes ranging from Class 1 (superpotent) through Class 7 (least potent). The step therapy program encourages trial of lower-cost, lower-potency or generic alternatives before coverage of higher-step or higher-cost agents.

When prior authorization is required for step therapy, approvals are issued for 12 months; providers should consider potency class when selecting initial agents and follow the required step sequencing outlined in the policy.