- PA Applies
- PA Applies
- Quantity Limit: limit maximum 30 day(s) supply limit maximum 15 EA PER fill retail
- Derm: Acne Vulgaris:
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Limited to non-cosmetic use: No
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