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diclofenac 3% gel — Blue Cross Blue Shield of Alabama

actinic (solar) keratoses of the trunk and/or extremities

Initial criteria

  • - Patient has an FDA-labeled indication
  • - Patient age is within FDA labeling or supported for the indication
  • - Diagnosis of actinic (solar) keratoses of the trunk and/or extremities
  • - Requested agent is one of the listed drugs