HealthNet - All plan years
Jublia (efinaconazole)
Drugs for the Skin : Drugs for the Skin
  • Prior Authorization: Derm: Onchomycosis:
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 48 week(s)
    Reauthorization Required: Yes

  • Derm: Onchomycosis:
    Age Requirement: >= 18
    Duration: 48 week(s)
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 48 week(s)
    Treatment for non-cosmetic purposes: No
    Documented Size of Fungal Infection: N/A
    Documented Trial and Failure Length of Generic Penlac: N/A
    Patient Must Not Also Be Using With an Oral Antifungal Agent: No
    Re-approval not allowed: No
    Supporting Documentation Requirements: Chart Notes
    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

  • Step Therapy: Derm: Onchomycosis:
    ST Single Generic