Emulsion SB — United Healthcare
atopic dermatitis
Initial criteria
- Diagnosis of one of the following: atopic dermatitis OR allergic contact dermatitis OR radiation dermatitis OR seborrheic dermatitis
- AND History of failure or contraindication to two OTC emollients (e.g. Aquaphor, Eucerin, Lubriderm, white petroleum; document name and duration of trial)
- AND History of failure or contraindication to two topical corticosteroids. Document topical corticosteroid name and duration of trial
Reauthorization criteria
- Documentation of a positive response to therapy
Approval duration
12 months