- Step Therapy: Derm: Acne Vulgaris:
ST Single Generic
- Prior Authorization: Derm: Acne Vulgaris:
Reauthorization Required: Yes
- Derm: Acne Vulgaris:
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: Unspecified
Limited to non-cosmetic use: No
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