Epsolay (benzoyl peroxide) — United Healthcare
rosacea
Preferred products
- topical metronidazole cream or gel (generic Metrocream, Metrogel)
- Finacea (azelaic acid 15%)
- Soolantra (ivermectin 1% cream)
Initial criteria
- Diagnosis of rosacea
- Treatment of inflammatory lesions
- History of failure (after a 30 day trial), contraindication or intolerance to two of the following: topical metronidazole cream or gel (generic Metrocream, Metrogel); Finacea (azelaic acid 15%); Soolantra (ivermectin 1% cream)
Reauthorization criteria
- Documentation of positive clinical response to therapy demonstrated by a reduction in inflammatory lesion counts
Approval duration
Initial: 6 months; Reauthorization: 12 months