CurrentColorado Rocky Mountain Health PlansPolicy 2025 P 2283-4
Epsolay® (benzoyl peroxide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plansopen_in_new
Defines prior authorization and medical necessity criteria for Epsolay (benzoyl peroxide) topical cream for treatment of inflammatory lesions of rosacea in adults for UnitedHealthcare Commercial plans under Colorado Rocky Mountain Health Plans; includes initial and reauthorization criteria, approval durations, and notes on automated approvals and exclusions.
Policy Summary
PayerColorado Rocky Mountain Health Plans
PolicyEpsolay® (benzoyl peroxide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plansopen_in_new
Policy CodePolicy 2025 P 2283-4
Change TypeAnnual reviews and prior additions (2022–2025)
Effective DateNov 1, 2025
Next Review Date
Key ActionPrior authorization is required and initial approval will be issued for 6 months when all initial criteria are met, including documentation of rosacea, inflammatory lesions, and history of failure/contraindication/intolerance to two specified topical agents (after a 30-day trial).
SourceLink
POLICY UPDATE CHANGES
Program created as Prior Authorization/Medical Necessity - Epsolay in 8/2022.
Added note that Epsolay typically excluded in 8/2023 and included Finacea as a trial option.
Annual review in 8/2024 with removal of step therapy statement and updated references.
Annual review in 8/2025 with no changes.
2Approval Durations (months): initial / reauth
3Required prior agents (choices)
1