AMZEEQ (minocycline)

AMZEEQ (minocycline)

SELF ADMINISTRATION

Indications for Prior Authorization:

• Indicated to treat inflammatory lesions of non-nodular moderate to severe acne vulgaris in patients 9 years of age and older
• Limitations of use: This formulation of minocycline has not been evaluated in the treatment of infections. To reduce the development of drug-resistant bacteria as well as to maintain the effectiveness of other antibacterial drugs, Amzeeq™ should be used only as indicated

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

• Patient is 9 years of age or older, AND
• Patient has inflammatory lesions of non-nodular moderate to severe acne vulgaris as confirmed by chart note documentation, AND
• Patient has failed to respond to the following (as supported by chart note documentation):
  • At least 2 prescription strength topical antibiotics (e.g. clindamycin, erythromycin), AND
  • Concomitant Differin OTC or another topical retinoid, AND
• Patient has tried and failed oral minocycline, AND
• Patient is not currently taking penicillin

Dosing:

• Apply a cherry-sized amount to affected areas once daily

Approval:

• 1 year