- Step Therapy: Derm: Acne Vulgaris:
ST Single Generic
- Derm: Acne Vulgaris:
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: Unspecified
Limited to non-cosmetic use: No
Supporting Documentation Requirements: Chart Notes
- Prior authorization required. Member should try alternative(s) before submitting a prior authorization. If approved, covered at appropriate tier under the member's pharmacy benefit.
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