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Topical Diclofenac – Diclofenac 3% Gel Prior Authorization Criteria - Medicare Part D
Prior Authorization Criteria for Approval
Diclofenac 3% gel will be approved when BOTH of the following are met:
- The patient has a diagnosis of actinic keratosis (AK)
AND - The patient does NOT have any FDA labeled contraindications to the requested medication
Length of Approval: 3 months
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