Contraceptive therapies (oral, topical, etc.) — Highmark
Concomitant use of isotretinoin or another known teratogen (pregnancy category X)
Initial criteria
- Diagnosis of one of the listed approved conditions (1–19)
- Contraceptive therapies will not be approved if the member has a diagnosis of contraception, emergency contraception, or any other diagnosis not previously mentioned
Approval duration
12 months