Limited Coverage Drugs - tretinoin topical

Generic Name / Strength / Form

tretinoin topical

Criteria

Approval Period

1. Diagnosis of acne.

OR

2. Diagnosis of skin cancer.

Indefinite

Practitioner Exemptions

  • No practitioner exemptions

Special Notes

  • Tretinoin topical for cosmetic indications is not eligible for PharmaCare coverage.

Special Authority Request Form(s)