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Prior Authorization/Preferred Drug List (PA/PDL) for Immunomodulators, Atopic Dermatitis – Topical

Assigned number Title Release date Language Available to order
F-02572 Prior Authorization/Preferred Drug List (PA/PDL) for Immunomodulators, Atopic Dermatitis – Topical (Word) 01/01/2025 English No
F-02572 Prior Authorization/Preferred Drug List (PA/PDL) for Immunomodulators, Atopic Dermatitis – Topical (PDF) 01/01/2025 English No
F-02572A Prior Authorization/Preferred Drug List (PA/PDL) for Immunomodulators, Atopic Dermatitis – Topical Instructions (PDF) 01/01/2025 English No

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Last revised September 9, 2026