| Anthem Blue Cross (HMO, PPO, EPO) |
| Absorica (isotretinoin) |
| Drugs for the Skin : Drugs for the Skin |
- Prior Authorization: Derm: Acne Vulgaris:
Duration: 1 year(s)
- Step Therapy: Derm: Acne Vulgaris:
ST Multiple Generics
- Derm: Acne Vulgaris:
Duration: 1 year(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Limited to non-cosmetic use: No
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