Corticosteroids Topical Brand Only Policy

Corticosteroids Topical (Brand Only) PA with Limit Policy 2435-C 04-2021 v2.pdf

PDF • 152.15 KB - November 24, 2021

Corticosteroid

Alclometasone
Amcinonide
Betamethasone
Clobetasol
Clocortolone
Desonide
Desoximetasone
Diflorasone
Fluocinolone
Fluocinonide
Flurandrenolide
Fluticasone
Halcinonide
Halobetasol
Hydrocortisone
Mometasone
Prednicarbate
Triamcinolone

Requires Prior Approval

Subject to Quantity Limits

Document Entity Terms

First Published

January 1, 2019

Last Updated

January 1, 2022