Amnesteem — CareFirst (Caremark)

Initial criteria

• Patient has a diagnosis of severe recalcitrant nodular acne vulgaris OR refractory acne vulgaris OR severe refractory rosacea
• Patient has tried and had an inadequate treatment response to ANY topical acne product AND an oral antibiotic (topical products include salicylic acid, benzoyl peroxide, azelaic acid, adapalene, tretinoin, tazarotene, clindamycin, erythromycin, or metronidazole for rosacea; oral antibiotics include minocycline, doxycycline, tetracycline, erythromycin, trimethoprim-sulfamethoxazole, trimethoprim, or azithromycin)
• Treatment will be limited to 40 weeks (2 courses) or less with at least 8 weeks between each course

Approval duration

12 months