Friday, June 22, 2012

Topical

KP Wellness

 10:20 AM  -  Public
5.1  Topical Corticosteroids
5.1.1  TOPICAL CORTICOSTEROIDS VERY HIGH POTENCY
TIER 1
Betamethasone Dipropionate/Propylene  Glycol Ointment
(Diprolene 0 .05%)
Clobetasol Propionate Cream (Temovate E 0 .05%)
Clobetasol Propionate Cream, Gel, Ointment (Temovate 0 .05%)
Clobetasol Propionate Solution, Non-Oral (Temovate 0 .05%)
Diflorasone Diacetate Ointment (Psorcon)
Halobetasol Propionate Cream, Ointment (Ultravate)
TIER 3
Clobetasol Propionate Foam (Olux)
Clobetasol Propionate (Clobex)
Clobex Shampoo  
Clobetasol Propionate Foam (Olux-E)

5.1.2  TOPICAL CORTICOSTEROIDS HIGH POTENCY
TIER 1
Amcinonide Cream, Ointment (Cyclocort 0 .1%)
Betamethasone Dipropionate Cream, Lotion,  Ointment
(Diprosone 0 .05%,  Maxivate 0 .05%)
Betamethasone Dipropionate/Propylene  Glycol Gel, Lotion
(Diprolene 0 .05%)
Betamethasone DP Augmented Cream  0.05%
(Diprolene AF Cream)
Betamethasone Valerate Ointment (Valisone 0 .1%)
Desoximetasone Cream, Ointment (Topicort 0 .25%)
Desoximetasone Gel (Topicort 0 .05%)
Diflorasone Diacetate Cream (Psorcon 0 .05%)
Diflorasone Diacetate/Emollient Cream (Psorcon E 0 .05%)
Fluocinonide Cream, Gel, Ointment,  Solution, Non-Oral
(Lidex 0 .05%)
Fluocinonide/Emollient Cream (Lidex-E 0 .05%)
Triamcinolone Acetonide Cream (Aristocort 0 .5%, Kenalog 0 .5%)
Triamcinolone Acetonide Ointment (Aristocort HP 0 .5%)
TIER 3
Halcinonide Cream (Halog)
Fluocinonide (Vanos)

5.1.3  TOPICAL CORTICOSTEROIDS MEDIUM POTENCY
TIER 1
Betamethasone Valerate Cream, Lotion (Valisone 0 .1%)
Desoximetasone Cream (Topicort Lp 0 .05%)
Fluocinolone Acetonide Cream, Ointment (Synalar 0 .025%)
Fluticasone Propionate Cream (Cutivate 0 .05%)
Fluticasone Propionate Ointment (Cutivate 0 .005%)
Hydrocortisone Butyrate Ointment, Solution,  Non-Oral
(Locoid 0 .1%)
Hydrocortisone Valerate Cream, Ointment (Westcort 0 .2%)
Mometasone Furoate Cream, Ointment,  Solution (Elocon)
Prednicarbate Cream (Dermatop 0 .1%)
Triamcinolone Acetonide Cream (Aristocort 0 .025%)
Triamcinolone Acetonide Cream, Ointment 
(Aristocort 0 .1%, Kenalog 0 .1%)
Triamcinolone Acetonide Lotion (Kenalog 0 .025%, 0 .1%)
TIER 3
Clocortolone (Cloderm)
Flurandrenolide Tape (Cordran)
Fluticasone Propionate Lotion (Cutivate Lotion)
Hydrocortisone Butyrate (Locoid Lipocream)
Locoid Lotion 
Hydrocortisone Probutate Cream (Pandel Cream)

5.1.4  TOPICAL CORTICOSTEROIDS LOW POTENCY
TIER 1
Alclometasone Dipropionate Cream,  Ointment 0.05%
(Aclovate 0 .05%)
Desonide Cream, Ointment
(DesOwen 0 .05%, Tridesilon 0 .05%)
Desonide Lotion (DesOwen 0 .05%)
Fluocinolone Acetonide Solution Non-Oral (Synalar 0 .01%)
Hydrocortisone Cream, Ointment (Hytone 2 .5%)
Hydrocortisone Lotion (Hytone 2 .5%)
TIER 3
Fluocinolone Acetonide (Derma-Smoothe/FS)
Desonide Gel (Desonate)
Desonide Foam (Verdeso)
5.3  Therapy For Acne
Some prescription non-combination benzoyl peroxide products 
are not covered . Numerous benzoyl peroxide products in 
various forms and strengths are available over-the-counter .
TIER 1
Clindamycin Phosphate (Cleocin T)
Erythromycin Base/Benzoyl Peroxide (Benzamycin)
Erythromycin Base/Ethyl Alcohol
(A/T/S, Emgel, Erygel, T-Stat)
Erythromycin Base/Ethyl Alcohol Swab,  Medicated (Erycette)
Metronidazole (Metrolotion)
Metronidazole Cream (Metrocream)
Metronidazole Gel (Metrogel 0 .75%)
Sulfacetamide Sodium/Sulfur 
(Clenia, Plexion, Sulfacet-R)
Sulfacetamide Sodium/Sulfur/Urea (Rosanil, Rosula)
Tretinoin Cream (Avita) 
Tretinoin Cream, Gel (Retin-A) 
TIER 2
Azelex (Azelaic Acid)
Benzamycin (Erythromycin Base/ Benzoyl Peroxide)
Benzaclin 1% - 5% 25 g  
(Clindamycin Phosphate/Benzoyl  Peroxide Gel) 
Differin Cream, Gel 0 .1%  (Adapalene) 
Isotretinoin (Accutane)
TIER 3
Benzoyl peroxide and Clindamycin phosphate Gel (Acanya)
Adapalene (Differin Cream, Gel 0 .1%) 
Tretinoin (Atralin)
Tretinoin Gel (Avita Gel)
Benzaclin 1%-5% 35, 50 g  
(Clindamycin Phosphate/Benzoyl  Peroxide Gel)
Clindagel SL Clindamycin Phosphate Foam 1% (Evoclin) 
Clindamycin Phosphate/Benzoyl  Peroxide Gel (Benzaclin 1%-5%)
Adapalene (Differin Gel 0 .3%)
Differin Lotion 
Clindamycin Benzoyl Peroxide (Duac)
Adapalene and benzoyl peroxide Gel 0.1%/2.5% (Epiduo)
Azelaic Acid (Finacea Gel)
Finacea Plus
Metronidazole (Metrogel 1%)
Metronidazole cream (Noritate)
Sodium Sulfacetamide 10%  and Sulfur 5% (Plexion Sct)
Sodium sulfacetamide 9% and sulfur 4% (Sumaxin TS)
Tretinoin Gel (Retin-A Micro)
Tretinoin Cream (Tretin-X)
Tazarotene Gel (Tazorac)
Clindamycin Phosphate and Tretinoin Gel 1.2%/0.025% (Veltin)
Clindamycin phosphate 1.2% and tretinoin 0.025% Gel  (Ziana)

5.4  Topical Antibacterials
TIER 1
Gentamicin Sulfate (Garamycin)
Mupirocin Ointment (Bactroban)
Sulfacetamide Sodium Suspension, Topical (Klaron)
TIER 3
Retapamulin (Altabax)
Mupirocin (Bactroban)
Mupirocin (Centany)

KP Wellness

 10:13 AM  -  Public
5.5  Topical Antifungals
TIER 1
Ciclopirox Cream, Gel, Lotion (Loprox 0 .77%) 
Ciclopirox Solution, Non-Oral (Penlac)
Clotrimazole/Betamethasone Dipropionate (Lotrisone)
Econazole Nitrate (Spectazole 1%)
Ketoconazole Cream (Nizoral 2%)
Ketoconazole Shampoo (Nizoral 2%) 
Nystatin (Mycostatin)
Nystatin/Triamcinolone Acetonide (Mycolog II)
TIER 2
Ciclopirox Shampoo (Loprox 1%) 
TIER 3
Sertaconazole Nitrate (Ertaczo)
Sulconazole (Exelderm)
Ketoconazole Foam (Extina) 
Ciclopirox Shampoo 1% [Rx Only] (Loprox Shampoo)
Butenafine (Mentax)
Naftifine (Naftin)
Oxiconazole (Oxistat)
Miconazole Nitrate, 15% Zinc Oxide, and 81.35% White Petrolatum (Vusion)
Ketoconazole (Xolegel)

5.6  Topical Antivirals
TIER 3
Penciclovir (Denavir)
Acyclovir and Hydrocortisone Cream (Xerese)
Acyclovir (Zovirax)

5.7  Burn Therapy
TIER 1
Silver Sulfadiazine (Silvadene)

5.8  Topical Enzymes
TIER 3
Balsam peru, Castor oil, Trypsin (Optase)
Balsam peru, Castor oil, Trypsin (Xenaderm)
Collagenase (Santyl)

5.9 Keratolytics
TIER 3
Salicylic acid 6% (Keralyt Scalp)

5.10 Antipsoriatic/Antiseborrheic
TIER 1
Calcipotriene Solution, Topical (Dovonex) 
Hydrocortisone Acetate/Pramoxine  Cream (Pramosone 2 .5%-1%)
Selenium Sulfide (Selsun Rx)
Sulfacetamide Sodium Cleanser (Ovace)
TIER 2
Calcipotriene Ointment (Dovonex)
Dovonex (Calcipotriene Cream)
Enbrel (Etanercept)
Soriatane (Acitretin)
Stelara (Ustekinumab) 
TIER 3
Adalimumab (Humira)
Calcipotriene and Betamethasone Dipropionate (Taclonex)
Taclonex Scalp 
Calcitriol Ointment (Vectical)

5.11  Topical Scabicides/Pediculicides
TIER 1
Malathion (Ovide)
Permethrin (Elimite)
TIER 2
Eurax (Crotamiton)
Lindane Lotion, Shampoo (Lindane) 

KP Wellness

 10:12 AM  -  Public
5.2  Topical Anesthetics
Local Anesthetics
TIER 1
Lidocaine HCl Gel, Ointment, Solution (Xylocaine)
TIER 2
Lidoderm (Lidocaine Adhesive Patch) 
TIER 3
Lidocaine/prilocaine (Emla)

5.12  Miscellaneous Dermatologicals
Note: OTC medications are not on the Prescription Drug List, 
but are listed for information purposes . 
AmLactin (Ammonium Lactate) - OTC
TIER 1
Aluminum Chloride (Drysol)
Doxepin Cream (Zonalon)
Fluorouracil (Efudex)
Podofilox Liquid (Condylox Liquid)
Sulfacetamide Sodium/Urea Lotion (Carmol 10%-10%)
Urea 40% Emulsion (Umecta)
Urea/Lactic Acid/Zn Undecylenate  Emulsion (Kerol)
TIER 2
Condylox Gel (Podofilox Gel)
Imiquimod (Aldara) 
Oxsoralen-Ultra (Methoxsalen, Rapid)
Protopic (Tacrolimus Ointment) N SL
Regranex (Becaplermin) 
TIER 3
Urea/hydrocortisone topical (Carmol HC Cream)
 Aluminum Chloride Solution (Drysol)
Pimecrolimus Cream (Elidel)
Alitretinoin Gel (Panretin Gel)
Diclofenac sodium 3% (Solaraze Gel)
Umecta  
Urea, 40% - Sodium hyaluronate 0.3% (Umecta PD)
Urea 45%  (Uramaxin GT)
Imiquimod Cream (Zyclara)

2 comments:

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