Health Net
Oracea (doxycycline monohydrate)
Drugs for the Skin : Drugs for the Skin
  • Prior Authorization: Derm: Rosacea:
    PA Applies
  • Quantity Limit: limit maximum 1 EA PER 1 day(s)
  • 1. FDA Approved Indications: a. For the treatment of only inflammatory lesions (papules and pustules) of rosacea in adult patients. 2. Health Net Approved Indications and Usage Guidelines: a. Treatment of inflammatory lesions (papules and pustules) of rosacea in adult patients; AND b. One month failure of or clinically significant adverse effects to immediate-release doxycycline 50mg. 3. Coverage is Not Authorized For: Treatment of non-inflammatory lesions in acne vulgaris or rosacea. 4. Authorization Limit: Length of Benefit.
  • Step Therapy: Derm: Rosacea:
    Step Applies
  • Derm: Rosacea:
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A

  • Step Therapy Exists in PA
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