- Step Therapy: Derm: Onychomycosis:
ST Multiple Generics
- Derm: Onychomycosis:
Duration: 48 week(s)
Medical Test Required: Yes
Reauthorization Required: No
Duration of Reauthorization: N/A
Treatment for non-cosmetic purposes: Yes
Documented Size of Fungal Infection: N/A
Documented Trial and Failure Length of Generic Penlac: >= 12 week(s)
Patient Must Not Also Be Using With an Oral Antifungal Agent: No
Re-approval not allowed: No
Supporting Documentation Requirements: 3 of Chart Notes;Medical Tests;Medication History
Documented Diagnosis: Yes
Size of fungal infection <= 50% involvement: No
Patient must have documented failure of at least 48 weeks of generic Penlac: No
Concomitant drug therapy not allowed: No
- Prior Authorization: Derm: Onychomycosis:
Documented Diagnosis: Yes
Medical Test Required: Yes
Duration: 48 week(s)
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