Anthem Blue Cross (HMO, PPO, EPO)
Claravis (isotretinoin)
Drugs for the Skin : Drugs for the Skin
  • Step Therapy Applies
  • Derm: Acne Vulgaris:
    Duration: 5 Month(s)
    Documented Diagnosis: No
    Medical Test Required: No
    Reauthorization Required: No
    Limited to non-cosmetic use: No
    Topical medication trialfailure for isotretinoin: Y
    Oral Acne medications trialfailure prior to isotretinoin: Y


  • For FAX form click HERE
    Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites:
     Log in to Surescripts
     Log in to CoverMyMeds; For details on drug coverage click HERE;
  • PA Applies
  • Prior Authorization: Derm: Acne Vulgaris:
    Duration: 5 Month(s)

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