| Health Net |
| Doryx 75 Mg TbEC (doxycycline hyclate) |
| Drugs for Infections : Antibiotics |
- Prior Authorization: Derm: Acne Vulgaris:
Documented Diagnosis: Yes
- Derm: Acne Vulgaris:
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Limited to non-cosmetic use: No
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