diclofenac sodium gel 3 percent (generic Solaraze) — CareFirst (Caremark)

Preferred products

• imiquimod 5 percent cream
• fluorouracil cream
• fluorouracil solution

Initial criteria

• The patient experienced an inadequate treatment response, intolerance, OR has a contraindication to ONE of the following: imiquimod 5 percent cream, fluorouracil cream or solution.

Reauthorization criteria

• The patient has achieved or maintained a positive clinical response as evidenced by improvement (e.g., percentage of actinic keratosis lesions cleared, patient/prescriber satisfaction, etc.).

Approval duration

3 months