Ecoza (econazole foam) — CareFirst (Caremark)
Candidiasis/Candida
Preferred products
- ciclopirox cream
- ciclopirox gel
- ciclopirox suspension/lotion
- clotrimazole cream
- clotrimazole solution
- ketoconazole cream
- luliconazole cream (Luzu)
- naftifine cream
- naftifine 1% gel (Naftin 1% gel)
- oxiconazole cream
- oxiconazole lotion
- sulconazole cream (Exelderm)
- sulconazole solution (Exelderm)
Initial criteria
- For Candidiasis/Candida: Authorization may be granted when the requested drug is being prescribed for the treatment of Candidiasis/Candida AND the requested drug is NOT being used in a footbath.
- For Tinea Corporis: Authorization may be granted when the requested drug is being prescribed for the treatment of Tinea Corporis AND the requested drug is NOT being used in a footbath.
- For Tinea Cruris: Authorization may be granted when the requested drug is being prescribed for the treatment of Tinea Cruris AND the requested drug is NOT being used in a footbath.
- For Tinea Pedis: Authorization may be granted when the requested drug is being prescribed for the treatment of Tinea Pedis AND the requested drug is NOT being used in a footbath.
- For Tinea (Pityriasis) Versicolor: Authorization may be granted when the requested drug is being prescribed for the treatment of Tinea (Pityriasis) Versicolor AND the requested drug is NOT being used in a footbath.
Approval duration
3 months