calcipotriene foam (authorized generic) — Cigna

Preferred products

• generic calcipotriene cream
• generic calcipotriene ointment
• generic calcipotriene solution

Initial criteria

• If the patient has tried one Step 1 Product (generic calcipotriene cream, generic calcipotriene ointment, or generic calcipotriene solution), approve a Step 2 Product.
• If the patient is age < 18 years, approve calcipotriene foam (authorized generic), generic calcipotriene-betamethasone dipropionate ointment, Enstilar foam, Sorilux foam, or Taclonex ointment.

Approval duration

1 year