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.
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.
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