UnitedHealthcare - 2014 to Present
Jublia (efinaconazole)
Drugs for the Skin : Drugs for the Skin
  • Step Therapy: Derm: Onchomycosis:
    ST Multiple Generics

  • Derm: Onchomycosis:
    Duration: 48 week(s)
    Medical Test Required: Yes
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Treatment for non-cosmetic purposes: Yes
    Documented Size of Fungal Infection: N/A
    Documented Trial and Failure Length of Generic Penlac: >= 12 week(s)
    Patient Must Not Also Be Using With an Oral Antifungal Agent: No
    Re-approval not allowed: No
    Supporting Documentation Requirements: 3 of Chart Notes;Medical Tests;Medication History
    Documented Diagnosis: Yes
    Size of fungal infection <= 50% involvement: No
    Patient must have documented failure of at least 48 weeks of generic Penlac: No
    Concomitant drug therapy not allowed: No

  • Prior Authorization: Derm: Onchomycosis:
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Duration: 48 week(s)