- PA_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
- ST_APPLIES
- Quantity Limit: 4 tablets per 1 day(s).
- Age Limit: This drug may require prior authorization if your age does not fall within manufacturer, FDA, or clinical recommendations.
At least 21 yrs old
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