Carac (fluorouracil) 0.5% topical cream — Highmark

Preferred products

• fluorouracil solution
• fluorouracil 5% cream
• imiquimod 5% topical cream

Initial criteria

• age ≥ 18 years
• diagnosis of multiple actinic keratoses (solar keratoses) (ICD-10: L57.0) of the face or anterior scalp
• therapeutic failure or intolerance to one of the following plan-preferred generic topical products: fluorouracil solution OR fluorouracil 5% cream
• therapeutic failure or intolerance to plan-preferred generic imiquimod 5% topical cream
• if request is for brand Carac, therapeutic failure or intolerance to fluorouracil 0.5% topical cream

Reauthorization criteria

• prescriber attests that the member previously responded to Carac 0.5% or fluorouracil 0.5% topical therapy
• prescriber attests that the member is experiencing recurrence of actinic keratosis
• if request is for brand Carac, therapeutic failure or intolerance to fluorouracil 0.5% topical cream

Approval duration

1 month