| HealthNet - All plan years |
| Epiduo Forte (adapalene-benzoyl peroxide) |
| Drugs for the Skin : Drugs for the Skin |
- ST_APPLIES
- Prior Authorization: Derm: Acne Vulgaris:
Duration: 1 year(s)
- PA_APPLIES
- Melanoma (MEL):
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Prior Authorization: PA_APPLIES
- PA_APPLIES
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