Differin Gel 0.3% — CareFirst (Caremark)

Initial criteria

• Authorization may be granted when the requested drug is being prescribed for the topical treatment of acne vulgaris
• If additional quantities are being requested, then the requested drug is being prescribed to treat a body surface area that requires additional quantities

Reauthorization criteria

• Authorization may be granted when the requested drug is being prescribed for the topical treatment of acne vulgaris and ALL of the following criteria are met:
• The patient has achieved or maintained a positive clinical response as evidenced by improvement (e.g., reduction in number of lesions, patient satisfaction, etc.)
• If additional quantities are being requested, then the requested drug is being prescribed to treat a body surface area that requires additional quantities

Approval duration

Initial therapy: 4 months; Continuation of therapy: 12 months