Zovirax (acyclovir 5% ointment – Bausch Health, generic) — Cigna

Preferred products

• acyclovir 5% ointment

Initial criteria

• Generic acyclovir 5% ointment is requested OR
• (i) Patient has tried generic acyclovir 5% ointment AND (ii) Patient cannot use the generic product due to a formulation difference in the inactive ingredient(s) [e.g., difference in buffers, emollients, emulsifiers, preservatives, surfactants] between the brand and the bioequivalent generic product which, per the prescriber, would result in a significant allergy or serious adverse reaction

Approval duration

1 year