Absorica LD — CareFirst (Caremark)

Initial criteria

• Patient has a diagnosis of neuroblastoma, cutaneous T-cell lymphoma (CTCL) (e.g., mycosis fungoides, Sézary syndrome), is at high risk for developing skin cancer (squamous cell cancers), transient acantholytic dermatosis (Grover’s Disease), keratosis follicularis (Darier Disease), lamellar ichthyosis, OR pityriasis rubra pilaris

Approval duration

12 months