Pliaglis (lidocaine and tetracaine) cream — Highmark
topical local analgesia for superficial dermatological procedures such as dermal filler injection, pulsed dye laser therapy, facial laser resurfacing, and laser-assisted tattoo removal
Preferred products
- lidocaine-prilocaine 2.5%-2.5% topical cream
Initial criteria
- Member is age ≥ 18 years.
- Member is using the product on intact skin to provide topical local analgesia for one of the following superficial dermatological procedures: dermal filler injection, pulsed dye laser therapy, facial laser resurfacing, or laser-assisted tattoo removal.
- Member has experienced therapeutic failure or intolerance to plan-preferred generic lidocaine-prilocaine 2.5%-2.5% topical cream.
Approval duration
3 months