Tazarotene (Fabior®; Tazorac®)

SELF-ADMINISTRATION - TOPICAL

FDA Approved Indications:
  • Fabior® and Tazorac® 0.1%: acne vulgaris 

  • Tazorac® 0.05% and 0.1%: plaque psoriasis
Treatment NOT authorized for the following conditions/products:
  • Palliation of fine facial wrinkles, facial mottled hyper-/hypopigmentation, benign facial lentigines
  • Avage®
Prior authorization criteria:
  • Tazorac® 0.05% or 0.1%: diagnosis of plaque psoriasis OR
  • Fabior® or Tazorac® 0.1%: Diagnosis of acne vulgaris (supported by chart note documentation); AND
  • Failure to respond to the following (supported by chart note documentation):
    • Prescription strength topical antibiotics (e.g. clindamycin, erythromcyin). NOTE: if patient has non-inflammatory acne, prescription strength topical antibiotics are not required; AND
    • Differin OTC; AND
    • tretinoin topical
  • In addition to the criteria above, requests for brand Tazorac® 0.1% gel: patients must try and fail generic tazarotene 0.1% cream
Approval:
  • One Year

Last review date: August 21, 2020

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