generic tacrolimus ointment (0.03% and 0.1% strengths) — Cigna

Preferred products

• prescription topical corticosteroids (brand or generic)

Initial criteria

• If the patient has tried a Step 1 Product (prescription topical corticosteroids), approve a Step 2 Product.
• OR If the patient has a dermatologic condition on or around the face, eyes/eyelids, axilla, or genitalia, approve a Step 2 Product.
• OR If the patient is age < 2 years, approve Eucrisa.

Approval duration

1 year