Health Net
Aklief (trifarotene)
Drugs for the Skin : Drugs for the Skin
  • Step Therapy: Derm: Acne Vulgaris:
    ST Single Generic

  • Prior Authorization: Derm: Acne Vulgaris:
    Documented Diagnosis: Yes
    Age Requirement: >= 9
    Duration: 12 Month(s)
    Reauthorization Required: Yes

  • Derm: Acne Vulgaris:
    Age Requirement: >= 9
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)
    Limited to non-cosmetic use: No
    Supporting Documentation Requirements: 1 of Chart Notes;Lab Tests

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