Cordran SP 0.05% cream — Cigna
symptomatic relief of inflammation and/or pruritus associated with corticosteroid-responsive dermatoses
Preferred products
- Alclometasone 0.05% ointment/cream
- Betamethasone dipropionate 0.05% cream/ointment/lotion
- Betamethasone dipropionate, augmented 0.05% cream/lotion/ointment
- Betamethasone valerate 0.1% cream/lotion/ointment
- Clobetasol propionate 0.05% cream/gel/ointment/solution
- Desonide 0.05% cream/ointment
- Fluocinolone acetonide 0.01% cream/solution
- Fluocinolone acetonide 0.025% cream/ointment
- Fluocinonide 0.05% cream/gel/ointment/solution
- Fluticasone propionate 0.05% cream/ointment
- Halobetasol propionate 0.05% cream/ointment
- Hydrocortisone 1%/2%/2.5%
- Hydrocortisone butyrate 0.1% emollient cream
- Hydrocortisone valerate 0.2% cream/ointment
- Mometasone furoate 0.1% cream/lotion/ointment
- Prednicarbate 0.1% cream/ointment
- Triamcinolone acetonide 0.025%/0.1%/0.5% formulations
Initial criteria
- Patient has tried and failed, or has contraindication/intolerance to TWO Step 1a generic topical corticosteroid products OR Step Therapy rule not met at point of service (as applicable for Step 2a products)
- Coverage will be granted if Step Therapy criteria are satisfied
Reauthorization criteria
- Continuation of therapy remains medically necessary as per clinical judgment and benefit plan; no additional step requirement indicated
Approval duration
1 year