Sutter Health Plus
Ziana (clindamycin-tretinoin)
Drugs for the Skin : Drugs for the Skin
  • Prior Authorization: Asthma (injectable), Asthma OCS Dependent:
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 6
    Duration: 6 Month(s)
    Reauthorization Required: Yes

    Atopic Dermatitis (Eczema):
    Documented Diagnosis: Yes
    Age Requirement: >= 1
    Duration: 6 Month(s)
    Reauthorization Required: Yes

    Eosinophilic Esophagitis (EoE):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 12
    Duration: 6 Month(s)
    Reauthorization Required: Yes

    Nasal Polyposis:
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Reauthorization Required: Yes

  • Prior Authorization: Hidradenitis Suppurativa (HS):
    Documented Diagnosis: Yes
    Age Requirement: >= 12
    Duration: 6 Month(s)
    Reauthorization Required: Yes

    Psoriasis (PsO):
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Reauthorization Required: Yes

    Uveitis:
    Documented Diagnosis: Yes
    Age Requirement: >= 2
    Duration: 6 Month(s)
    Reauthorization Required: Yes

  • Prior Authorization: PA Applies

  • 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;