- Prior Authorization: Derm: Rosacea:
PA Applies
- Step Therapy: Derm: Rosacea:
Step Applies
- Derm: Rosacea:
Age Requirement: >= 18
Duration: 1 plan year
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 1 plan year
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