Diclofenac (Solaraze)

SELF-ADMINISTRATION - TOPICAL

Indications for Prior Authorization:

  • Treatment of actinic keratoses (AK)

Patients must meet the following criteria for the indication(s) above:

  • Diagnosis of actinic keratosis, AND

  • 18 years or older, AND
  • Patient has failed or is not a good candidate for liquid nitrogen cryotherapy and surgical curettage, AND
  • Patient has tried and failed topical 5-FU

Dosing:

  • Apply to lesion area twice daily for 60 to 90 days

Approval:

  • 3 months

Last review date: June 5, 2017