mometasone furoate — CareFirst (Caremark)
Treatment of psoriasis
Initial criteria
- Authorization may be granted when the requested drug is being prescribed for a corticosteroid-responsive dermatosis or condition (e.g., atopic dermatitis, eczema, psoriasis, seborrheic dermatitis) AND
- The requested drug is NOT being used in a footbath
Approval duration
6 months