BP Cleansing Wash — Medica
seborrheic dermatitis
Preferred products
- BenzePrO (benzoyl peroxide) 6% Foaming Cloths
- PR Benzoyl Peroxide 7% Wash
- Sulfacetamide Sodium/Sulfur 10%-5% Topical Cleanser
Initial criteria
- Patient has tried one Step 1 Product (BenzePrO (benzoyl peroxide) 6% Foaming Cloths OR PR Benzoyl Peroxide 7% Wash OR Sulfacetamide Sodium/Sulfur 10%-5% Topical Cleanser) within the 130-day look-back period.
Reauthorization criteria
- No reauthorization criteria specified; continue coverage per initial approval if criteria remain met.
Approval duration
1 year