Zonalon — United Healthcare
moderate pruritus due to lichen simplex chronicus
Preferred products
- topical corticosteroids
- topical calcineurin inhibitors
- mometasone furoate
- fluocinolone acetonide
- fluocinonide
- pimecrolimus
- tacrolimus
Initial criteria
- Diagnosis of moderate pruritus due to atopic dermatitis AND history of failure, contraindication, or intolerance to ONE of the following topical therapies: ONE topical corticosteroid [e.g., mometasone furoate, fluocinolone acetonide (generic Synalar), fluocinonide] OR ONE topical calcineurin inhibitor [e.g., pimecrolimus (generic Elidel), tacrolimus (generic Protopic)]
- OR
- Diagnosis of moderate pruritus due to lichen simplex chronicus AND history of failure, contraindication, or intolerance to a topical corticosteroid [e.g., mometasone furoate, fluocinolone acetonide (generic Synalar), fluocinonide]
Approval duration
1 month