Anthem Blue Cross (HMO, PPO, EPO)
Plixda (adapalene)
Drugs for the Skin : Drugs for the Skin
  • Step Therapy Applies
  • Prior Authorization: Derm: Acne Vulgaris:
    Documented Diagnosis: Yes
    Duration: 1 year(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
    Supporting Documentation Requirements: Chart Notes

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