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generic doxycycline monohydrate 40 mg capsule — Point32Health

treatment of inflammatory lesions (papules and pustules) of rosacea in adult patients

Preferred products

  • preferred doxycycline hyclate formulation
  • preferred doxycycline monohydrate formulation

Initial criteria

  • The patient has had a trial of one (1) Step-1 or Step-2 medication within the previous 180 days as evidenced by a previous paid claim under the prescription benefit administered by the plan.
  • OR The patient has had a trial and failure of one (1) Step-1 medication.