| Anthem Blue Cross (HMO, PPO, EPO) |
| Amzeeq (minocycline) |
| Drugs for the Skin : Drugs for the Skin |
- Step Therapy Applies
- Quantity Limit: 30 grams per 30 day(s).
- Derm: Acne Vulgaris:
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Limited to non-cosmetic use: No
- Prior Authorization: Derm: Acne Vulgaris:
Documented Diagnosis: Yes
Duration: 1 year(s)
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