- Step Therapy: Derm: Rosacea:
Step Applies
- Derm: Rosacea:
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
- Quantity Limit: limit maximum 30 GM PER fill retail
- Prior Authorization: Derm: Rosacea:
PA Applies
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