Bexarotene Targretin 1795 A Sgm P2023
Defines covered indications (FDA-approved and compendial) for oral bexarotene (Targretin) capsules and topical bexarotene 1% gel, authorization durations, and continuation criteria for members when approval criteria are met and no exclusions exist. Declares all other indications experimental/investigational and not medically necessary.
No material changes to clinical coverage or criteria.
Coverage Summary
Defines covered indications for oral bexarotene (Targretin) capsules and topical bexarotene 1% gel (Targretin and generics). Coverage stance: covered_with_criteria — FDA-approved and compendial indications are covered provided all approval criteria are met and the member has no exclusions. Authorization durations and continuation/reauthorization criteria are specified (typically 12 months where applicable). All other indications are considered experimental/investigational and not medically necessary.
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