butenafine cream (Mentax) — CareFirst (Caremark)
Tinea (Pityriasis) Versicolor
Preferred products
- ciclopirox cream
- ciclopirox suspension/lotion
- clotrimazole cream
- clotrimazole solution
- econazole cream
- ketoconazole cream
- ketoconazole shampoo
- oxiconazole cream
- sulconazole cream
- sulconazole solution
Initial criteria
- Authorization may be granted when the requested drug is being prescribed for the treatment of Tinea (Pityriasis) Versicolor when ALL of the following criteria are met:
- The requested drug is NOT being used in a footbath.
- The requested drug is ANY of the following: butenafine cream (Mentax), ciclopirox cream, suspension/lotion (Loprox cream, suspension/lotion), clotrimazole cream, solution, econazole cream, ketoconazole cream, shampoo, oxiconazole cream (Oxistat cream), sulconazole cream, solution (Exelderm).
Approval duration
3 months