Effective Jan. 1, 2027, Sanford Health Plan is updating prior authorization requirements for skin substitute products for Medicare Advantage members.

Sanford Health Plan Medicare Advantage plans will provide coverage without prior authorization for up to 10 applications within a 12-week period per wound for any Medicare-covered skin substitute product. The limitation is 10 applications regardless if the skin substitute(s) used are all the same or a combination of different skin substitutes.

There will be no limit on the number of covered applications for the treatment of breast cancer-related wounds or burns. For all other diagnoses, prior authorization will be required for treatment plans exceeding 10 applications within a 12-week period.

Providers should note that only the skin substitute products allowed by Medicare are eligible for coverage and all others are considered non-covered.