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The Policy VaultThe Policy Vault

Absorica LDUnited Healthcare

acne

Preferred products

  • Claravis
  • Myorisan
  • Zenatane
  • Amnesteem
  • isotretinoin 10mg/20mg/30mg/40mg

Initial criteria

  • (1) Must try one topical retinoid or retinoid-like agent [e.g., Retin-A/Retin-A Micro (tretinoin)]
  • AND (1) Must try one oral antibiotic [e.g., erythromycin, minocycline]
  • AND (1) Must try one topical antibiotic with or without benzoyl peroxide [e.g., clindamycin, erythromycin, BenzaClin, Benzamycin]
  • AND (2) Must try two of the following oral isotretinoin formulations (document duration of trial): Claravis, Myorisan, Zenatane, Amnesteem, isotretinoin 10mg, 20mg, 30mg, 40mg