Prudoxin (doxepin) — United Healthcare
Moderate pruritus due to lichen simplex chronicus
Initial criteria
- Diagnosis of moderate pruritus due to one of the following: atopic dermatitis OR lichen simplex chronicus
Reauthorization criteria
- Diagnosis of moderate pruritus due to either atopic dermatitis or lichen simplex chronicus
- Documentation of positive clinical response to therapy
Approval duration
1 month