| Anthem Blue Cross (HMO, PPO, EPO) |
| Accutane (isotretinoin) |
| Drugs for the Skin : Drugs for the Skin |
- Step Therapy Applies
- Prior Authorization: Derm: Acne Vulgaris:
Duration: 5 Month(s)
- Derm: Acne Vulgaris:
Duration: 5 Month(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Limited to non-cosmetic use: No
Topical medication trialfailure for isotretinoin: Y
Oral Acne medications trialfailure prior to isotretinoin: Y
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