Fabior (tazarotene foam) — CareFirst (Caremark)

Initial criteria

• The requested drug is being prescribed for the topical treatment of acne vulgaris

Reauthorization criteria

• The requested drug is being prescribed for the topical treatment of acne vulgaris
• The patient has achieved or maintained a positive clinical response as evidenced by improvement (e.g., reduction in number of lesions, patient satisfaction, etc.)

Approval duration

Initial: 4 months; Continuation: 36 months (Policy 1005-A)