Tazarotene (Fabior; Tazorac)

SELF-ADMINISTRATION - TOPICAL

FDA Approved Indications:

  • Fabior and Tazorac 0.1%: acne vulgaris

  • Tazorac 0.05% and 0.1%: psoriasis

Treatment NOT authorized for the following conditions/products:

  • Palliatin of fine facial wrinkles, facial mottled hyper-/hypopigmentation, benign facial lentigines
  • Avage

Prior authorization criteria:

  • Tazorac 0.05% or 0.1%: diagnosis of 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

Approval:

  • One Year

Last review date: May 9, 2017