Absorica — Highmark
severe nodular acne
Preferred products
- Amnesteem
- Claravis
- Myorisan
- Zenatane
- Accutane
Initial criteria
- age ≥ 12 years
- Diagnosis of acne (ICD-10: L70.0) classified as severe nodular acne
- Therapeutic failure or intolerance to one generic topical acne product from two different therapeutic categories (topical retinoids AND topical antibiotics), or all topical acne products contraindicated
- Therapeutic failure or intolerance to at least one oral antibiotic indicated for the treatment of acne (e.g., minocycline IR, tetracycline, doxycycline), or all oral antibiotics contraindicated
- Therapeutic failure or intolerance to one plan-preferred agent (Amnesteem, Claravis, Myorisan, Zenatane, or Accutane)
Reauthorization criteria
- Member has not received isotretinoin therapy for at least 8 weeks after completion of the initial course
- Member has experienced persistent or recurring severe acne following the initial course of isotretinoin therapy
Approval duration
5 months