Retin-A Micro Pump — Medical Mutual
Acne vulgaris
Preferred products
- Generic adapalene
- Generic adapalene/benzoyl peroxide combination
- Generic clindamycin/tretinoin combination
- Generic tazarotene
- Generic tretinoin
Initial criteria
- Patient age ≥ 18 years
- Patient has had an inadequate response, experienced intolerance, OR has a contraindication to one preferred topical retinoid product
Reauthorization criteria
- Response to therapy is required for continuation of therapy
Approval duration
1 year