Anthem Blue Cross (HMO, PPO, EPO)
Picato (ingenol mebutate)
Drugs for the Skin : Drugs for the Skin
  • Prior Authorization: Actinic Keratosis:
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 1 year(s)
    Reauthorization Required: Yes

  • Actinic Keratosis:
    Age Requirement: >= 18
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: Unspecified

  • Step Therapy: Actinic Keratosis:
    ST Single Generic

  • Quantity Limit: 3 tube per 365 day(s).
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