Tazarotene (Fabior; Tazorac)

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