HealthNet - All plan years
Aczone (dapsone)
Drugs for the Skin : Drugs for the Skin
  • Quantity Limit: 200 syringes per 30 day(s).
  • Prior Authorization: PA_APPLIES
  • 1;
  • Step Therapy: ADHD:
    ST Single Generic

  • Prior Authorization: Behcet's Disease:
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 12 Month(s)
    Reauthorization Required: Yes

    Psoriasis (PsO), Psoriatic Arthritis (PsA):
    Documented Diagnosis: Yes
    Duration: 12 Month(s)
    Reauthorization Required: Yes