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
Last review date: February 18, 2020