- Step Therapy: Derm: Onychomycosis:
ST Single Generic
- Prior Authorization: Derm: Onychomycosis:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 48 week(s)
Reauthorization Required: Yes
- Derm: Onychomycosis:
Age Requirement: >= 18
Duration: 48 week(s)
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 48 week(s)
Treatment for non-cosmetic purposes: No
Documented Size of Fungal Infection: N/A
Documented Trial and Failure Length of Generic Penlac: N/A
Patient Must Not Also Be Using With an Oral Antifungal Agent: No
Re-approval not allowed: No
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
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