Retin-A — Medical Mutual
Stable plaque psoriasis of up to 20% body surface area involvement
Preferred products
- Generic adapalene
- Generic adapalene/benzoyl peroxide combination
- Generic clindamycin/tretinoin combination
- Generic tazarotene
- Generic tretinoin
Initial criteria
- Patient age > 30 years
- Patient is using the requested medication for the treatment of acne vulgaris OR
- Patient is using generic tazarotene for the treatment of stable plaque psoriasis of up to 20% body surface area involvement
Reauthorization criteria
- Response to therapy is required for continuation of therapy
Approval duration
1 year