nystatin cream — CareFirst (Caremark)

Initial criteria

• Authorization may be granted when the requested drug is being prescribed for the treatment of Candidiasis/Candida when ALL of the following criteria are met:
• The requested drug is NOT being used in a footbath.
• The requested drug is ANY of the following: 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.

Approval duration

3 months