Zyclara (imiquimod) cream 2.5% — Highmark

Preferred products

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

Initial criteria

• age ≥ 18 years
• diagnosis of actinic keratosis (ICD-10: L57.0)
• therapeutic failure or intolerance to plan‑preferred generic imiquimod 5% cream
• therapeutic failure or intolerance to one of the following plan‑preferred agents: fluorouracil 5% topical cream OR fluorouracil topical solution

Reauthorization criteria

• prescriber attests member has experienced positive clinical response to therapy
• prescriber attests member requires additional courses of treatment

Approval duration

up to 16 weeks