Pharmacy Prior Authorization Criteria

Halcinonide cream

Indications for Prior Authorization

Halcinonide cream

• For diagnosis of Corticosteroid-responsive dermatoses
  Indicated for the relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses.

Criteria

Halcinonide cream

Step Therapy

Length of Approval: 12 Month(s)

• Requested drug is being used for a Food and Drug Administration (FDA)-approved indication
AND
• Trial and failure (minimum 30-day supply), contraindication, or intolerance to three of the following generics:
• betamethasone dipropionate 0.05% ointment
• betamethasone augmented 0.05% cream
• desoximetasone 0.25% cream
• fluocinonide 0.05% solution
• fluocinonide 0.05% cream
• fluocinonide 0.05% gel
• fluocinonide 0.05% ointment

P & T Revisions

2026-05-21, 2025-12-18, 2025-03-04, 2024-03-06, 2023-07-06, 2022-07-07, 2021-07-06

References

1. Halcinonide Prescribing Information. Glasshouse Pharmaceuticals Limited Canada. Ontario, Canada. October 2025.

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Revision History

• 2026-05-21: 2026 Annual Review: Updated trial/failure verbiage to include "minimum 30-day supply" to align with standard verbiage. Updated references.
• 2025-12-18: no criteria changes, added IL statute operational note
• 2025-03-04: Annual review: No criteria changes. Updated references.
• 2024-03-06: Annual review: No updates required.
• 2023-07-06: Annual review: No updates required.
• 2022-07-07: Annual review: Updated criteria and background.
• 2021-07-06: new ST program

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