ACNE AGENTS: TOPICAL
Displaying 1 - 10 of 212 records found.| Brand Name/Generic Name | NDC/Manufacturer | FFS Clinical Prior Auth Required | PDL Prior Auth Required | Programs |
|---|---|---|---|---|
| ACNE MEDICATION 10% GEL benzoyl peroxide |
00536105625 RUGBY |
No | No | Medicaid CSHCN |
| ACNE MEDICATION 10% GEL benzoyl peroxide |
00536105656 RUGBY |
No | No | Medicaid CSHCN |
| ACNE MEDICATION 10% LOTION benzoyl peroxide |
00536105875 RUGBY |
No | No | Medicaid CSHCN |
| ACNE MEDICATION 5% GEL benzoyl peroxide |
00536105525 RUGBY |
No | No | Medicaid CSHCN |
| ACNE MEDICATION 5% GEL benzoyl peroxide |
00536105556 RUGBY |
No | No | Medicaid CSHCN |
| ACNE MEDICATION 5% LOTION benzoyl peroxide |
00536105775 RUGBY |
No | No | Medicaid CSHCN |
| BENZOYL PEROXIDE 10% GEL benzoyl peroxide |
45802030801 PERRIGO/PADAGIS |
No | No | Medicaid CSHCN |
| BENZOYL PEROXIDE 10% GEL benzoyl peroxide |
45802030896 PADAGIS |
No | No | Medicaid CSHCN |
| BENZOYL PEROXIDE 10% WASH benzoyl peroxide |
35573045408 BUREL PHARMACEU |
No | No | Medicaid CSHCN |
| BENZOYL PEROXIDE 10% WASH benzoyl peroxide |
35573045491 BUREL PHARMACEU |
No | No | Medicaid CSHCN |