Skip to content
The Policy VaultThe Policy Vault

Synera (lidocaine 70 mg/tetracaine 70 mg patch) — Blue Cross Blue Shield of New Mexico

Local dermal analgesia for superficial dermatological procedures such as excision, electrodessication, and shave biopsy of skin lesions

Initial criteria

  • The requested agent will be used for one of the listed indications AND
  • The patient does NOT have any FDA labeled contraindications to the requested agent
  • If applicable, chart notes are required as indicated in criteria

Approval duration

12 months