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2025年1月1日，高级公式排除和首选专业事先授权要求
局部痤疮治疗aklief，veltin adapalene，adapalene/苯甲酰二氧化物，克林霉素凝胶/乳液/溶液，克林霉素/苯甲酰霉素过氧化
2025年1月1日，国家绩效配方排除和首选专业事先授权要求
Cabtreo gel adapalene, benzoyl peroxide, clindamycin topical, Epiduo Forte, Onexton, Twyneo clindamycin phosphate-benzoyl peroxide gel 1.2-3.75% Onexton Differin lotion adapalene, tretinoin cream/gel, Retin-A micro gel 0.06% and 0.08% Winlevi adapalene, clindamycin topical, dapsone, tazarotene cream, tretinoin cream Topical Anesthetics ZTlido lidocaine patch Topical Antifungals Jublia ciclopirox, terbinafine Topical Anti-Infectives Epsolay, Noritate azelaic acid gel, ivermectin 1%, metronidazole cream/gel/lotion, Finacea泡沫，soolantra，Zilxi Rhofade Brimonidine凝胶，Mirvaso局部皮质类固醇
Beal Bank 达拉斯地区科学与工程博览会 2020 获奖者
Ananya Chawla | 痤疮药物中的活性成分过氧化苯甲酰、阿达帕林、克林霉素、水杨酸和维甲酸的不同浓度对大肠杆菌的影响，在 3 天内每 24 小时测量一次。
ump（arrayrx）首选药物清单（PDL）2025
抗糖尿病层1- acarbose tab（previv）β阻滞剂1- acebutolol cap（Acebutolol Cap（e e e epiv）镇痛药 - 阿片类药物2 QL乙酰氨基酚/咖啡因/咖啡因/咖啡因/二氢可源性drocoseine tabs/for for 20或for for 20或for for 20或for for 20或for 20年龄; 90 days) ANALGESICS - OPIOID Tier 1 QL acetaminophen/codeine tab (TYLENOL/CODEINE equiv) (QL= 18 tabs/fill for members age 20 or younger; QL= 42 tabs/fill for members age 21 or older; Day supply limit of 42 days in 90 days) MIGRAINE PRODUCTS Tier 1 - acetaminophen/isometheptene/dichloral cap (MIDRIN equiv) MIGRAINE PRODUCTS Tier 2 - ACETAMINOPHEN/ISOMETHEPTENE/DICHLORAL CAP DIURETICS Tier 1 - acetazolamide ER cap (DIAMOX SEQUEL equiv) DIURETICS Tier 1 - acetazolamide tab OTIC AGENTS Tier 1 - acetic acid otic soln (VOSOL equiv) OTIC AGENTS Tier 1 - ACETIC ACID/ALUMINUM ACETATE OTIC SOLN COUGH/COLD/ALLERGY第1层 - 乙酰半胱氨酸溶液（Mucomyst Equiv）皮肤病学层2型抗凝集素帽（Soriatane Equiv）（阶梯疗法）需要对Adapalene，Adapalene/Adapalene/Adapalene/Benzoyl过氧化物或维美替诺蛋白）进行试验。Tier 2专业LD-PA ACTHAR HP凝胶ING（仅通过Accredo 800-803-2523或Walgreens 888-347-3416）内分泌和代谢剂 - Misc。Tier 2专业LD-PA Acthar Inj 80unit（仅通过认证800-803-2523或Walgreens 888-347-3416）咳嗽/冷/冷/过敏2 Ql actier 2 ql actier液体液体（Ql = 1200ml/30天） Acuvail Ophth Soln抗病毒药层1-阿塞克洛维尔帽（Zovirax equiv）皮肤病学系列2- acyclovir Cream（Zovirax equiv）
事先授权/分步治疗计划
Absorica/Absorica LD、阿达帕林、AirDuo Respiclick、Ala‑Scalp、Alphagan‑P、Amrix、Aplenzin、Ativan、Azelex、Bethkis、Bupap、Cafergot、Cambia/双氯芬酸、马来酸卡比沙明 6 毫克、氯唑沙宗/ Parafon Forte、Cordran、Coxanto、Cuprimine、Denavir 乳膏 1%、双氯芬酸钾、二氟拉松/ Psorcon 乳膏、二氟拉松软膏、Doral、硝酸益康唑 1% 泡沫、肾上腺素、Ertaczo 2% 乳膏、Exelderm 1% 乳膏、Exelderm 1% 溶液、Extina、非诺洛芬、非诺贝特 120 毫克、Fexmid/环苯扎林、氟西泮、Halog、Innopran XL、Kenalog 喷雾、酮洛芬 25 mg、酮洛芬 50 mg、酮洛芬 ER 200 mg、Konvomep 悬浮液、Lexette、Librax、Lorzone、Luzu 1% 乳膏、甲芬那酸、莫匹罗星乳膏、萘替芬 1% 乳膏、Naftin 2% 乳膏、Naftin 1% 凝胶、Naftin 2% 凝胶、Nalfon、Naprelan、Noritate、Oxistat、磷酸氢钙滴眼液、泼尼松龙磷酸钠溶液、泼尼松龙片剂、Reltone、Rhofade、Sitavig、Sorilux、Sovuna、TOBI/Kitabis、TOBI Podhaler、Treximet 85/500 mg、Vivlodex、Wellbutrin XL、Xerese、Zcort、Zegerid/奥美拉唑碳酸氢钠、Zembrace、Zipsor、Zovirax 乳膏 5%、Zyflo、Zyflo CR/齐留通缓释片
Prior Authorization/Step Therapy Program
Absorica/Absorica LD, Adapalene, AirDuo Respiclick, Ala‑Scalp, Alphagan‑P, Amrix, Aplenzin, Ativan, Azelex, Bethkis, Bupap, Cafergot, Cambia/diclofenac, Carbinoxamine Maleate 6mg, Chlorzoxazone/ Parafon Forte, Cordran, Coxanto, Cuprimine, Denavir Cream 1%, diclofenac potassium, Diflorasone/ Psorcon cream, diflorasone ointment, Doral, Econazole Nitrate 1% foam, Epinephrine, Ertaczo2% cream, Exelderm 1% cream, Exelderm 1% solution, Extina, Fenoprofen, fenofibrate 120 mg, Fexmid/cyclobenzaprine, Flurazepam, Halog, Innopran XL, Kenalog spray, Ketoprofen 25 mg, Ketoprofen 50 mg, Ketoprofen ER 200 mg, Konvomep suspension, Lexette, Librax, Lorzone, Luzu 1% cream, mefenamic acid, mupirocin cream, naftifine 1% cream, Naftin 2% cream, Naftin 1% gel, Naftin 2% gel, Nalfon, Naprelan, Noritate, Oxistat, phospholine ophthalmic solution, prednisolone sodium phosphate solution, prednisolone tablet, Reltone, Rhofade, Sitavig, Sorilux, Sovuna, TOBI/Kitabis, TOBI Podhaler, Treximet 85/500 mg, Vivlodex, Wellbutrin XL, Xerese, Zcort, Zegerid/omeprazole‑sodium bicarbonate, Zembrace, Zipsor, Zovirax cream 5%, Zyflo, Zyflo CR/ zileuton CR