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ketoconazole shampoo — CareFirst (Caremark)

Tinea Cruris

Initial criteria

  • Candidiasis/Candida: Authorization may be granted when the requested drug is prescribed for Candidiasis/Candida AND the drug is NOT being used in a footbath AND the drug is any of: ciclopirox cream, suspension/lotion (Loprox cream, suspension/lotion); clotrimazole cream, solution; econazole cream; ketoconazole cream; miconazole-zinc oxide-white petrolatum ointment (Vusion); nystatin cream, ointment, powder.
  • Seborrheic Dermatitis: Authorization may be granted when the requested drug is prescribed for Seborrheic Dermatitis AND the drug is NOT being used in a footbath AND the drug is any of: ciclopirox gel, shampoo (Loprox shampoo); ketoconazole cream, foam, shampoo.
  • Tinea Corporis: Authorization may be granted when the requested drug is prescribed for Tinea Corporis AND the drug is NOT being used in a footbath AND the drug is any of: ciclopirox cream, gel, suspension/lotion (Loprox cream, suspension/lotion); clotrimazole cream, solution; econazole cream; ketoconazole cream; luliconazole cream (Luzu); naftifine cream, 1% gel (Naftin 1% gel); oxiconazole cream, lotion (Oxistat); sulconazole cream, solution (Exelderm).
  • Tinea Cruris: Authorization may be granted when the requested drug is prescribed for Tinea Cruris AND the drug is NOT being used in a footbath AND the drug is any of: ciclopirox cream, suspension/lotion (Loprox cream, suspension/lotion); clotrimazole cream, solution; econazole cream; ketoconazole cream; luliconazole cream (Luzu); naftifine cream, 1% gel (Naftin 1% gel); oxiconazole cream, lotion (Oxistat); sulconazole cream, solution (Exelderm).
  • Tinea Pedis: Authorization may be granted when the requested drug is prescribed for Tinea Pedis AND the drug is NOT being used in a footbath AND the drug is any of: ciclopirox cream, gel, suspension/lotion (Loprox cream, suspension/lotion); clotrimazole cream, solution; econazole cream, foam (Ecoza); ketoconazole cream; luliconazole cream (Luzu); naftifine cream, gel (Naftin); oxiconazole cream, lotion (Oxistat); sertaconazole cream (Ertaczo); sulconazole cream (Exelderm cream).
  • Tinea (Pityriasis) Versicolor: Authorization may be granted when the requested drug is prescribed for Tinea (Pityriasis) Versicolor AND the drug is NOT being used in a footbath AND the drug is any of: 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