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Drug Category: Dermatological

Medication Class/Individual Agents: Corticosteroids

I. Prior-Authorization Requirements

 Topical Corticosteroids – Class I. Superpotent

Clinical Notes

Drug Details

Drug Generic Name

Drug Brand Name

PA
Status

betamethasone augmented gel test  
betamethasone dipropionate lotion, ointment test  
betamethasone dipropionate, augmented ointment Diprolene # test  
clobetasol propionate / emollient Temovate E # test  
clobetasol propionate cream, ointment Temovate # test  
clobetasol propionate foam Olux PA  
clobetasol propionate foam / emollient Olux-E PA  
clobetasol propionate gel, shampoo kit PA  
clobetasol propionate lotion, shampoo, spray Clobex PA  
clobetasol propionate powder PA  
clobetasol propionate solution test  
diflorasone ointment PA  
fluocinonide 0.1% cream Vanos PA  
flurandrenolide tape Cordran PA  
halobetasol / lactic acid Ultravate X PA  
halobetasol cream, ointment Ultravate # test  
halobetasol foam Lexette PA  
halobetasol lotion Bryhali PA  
halobetasol lotion Ultravate PA  

Please note: In the case where the prior authorization (PA) status column indicates PA, both the brand and generic (if available) require PA. Typically, the generic is preferred when available unless the brand-name drug appears on the MassHealth Brand Name Preferred Over Generic Drug List. In general, when requesting the non-preferred version, whether the brand or generic, the prescriber must provide medical records documenting an inadequate response or adverse reaction to the preferred version, in addition to satisfying the criteria for the drug itself.

 

Product Potency:

  • Relative potency of a product depends on the characteristics and concentration of the drug and the vehicle. 
  • Generally, ointments and gels are more potent than creams or lotions; however, some products have been formulated to yield comparable potency.

Product Selection:

  • Selection of a specific corticosteroid, strength, and vehicle depends on the nature, location, and extent of the skin condition, patient’s age, and anticipated duration of treatment.
  • Use the least-potent corticosteroid that would be effective.
  • Low-potency agents are preferred for the face, intertriginous areas (e.g., groin, axilla), large areas, and children, to reduce the potential for side effects.
  • Reserve higher-potency agents for areas and conditions resistant to treatment with milder agents.

Adverse Reactions:

  • Systemic absorption of topical corticosteroids has produced reversible hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing’s syndrome, hyperglycemia, and glycosuria.
  • Conditions that augment systemic absorption include application of more-potent steroids, use over large surface areas, prolonged use, addition of occlusive dressings, and patient’s age.
  • Perform appropriate clinical and laboratory tests if a topical corticosteroid is used for long periods or over large areas of the body.

With chronic conditions, gradual discontinuation of therapy may reduce the chance of rebound.

 

 Topical Corticosteroids – Class II. Potent

Drug Details

Drug Generic Name

Drug Brand Name

PA
Status

amcinonide ointment PA  
betamethasone dipropionate cream test  
betamethasone dipropionate spray Sernivo PA  
betamethasone dipropionate, augmented cream Diprolene AF # test  
betamethasone dipropionate, augmented lotion Diprolene # test  
desoximetasone 0.25% cream, ointment, spray, 0.05% gel Topicort PA  
diflorasone cream / emollient Apexicon-E PA  
fluocinonide cream, gel, ointment, solution test  
halcinonide cream, ointment Halog PA  
mometasone ointment Elocon # test  
triamcinolone 0.5% ointment test  

 Topical Corticosteroids – Class III. Upper Mid-Strength Potent

Drug Details

Drug Generic Name

Drug Brand Name

PA
Status

amcinonide cream PA  
amcinonide lotion test  
betamethasone valerate foam Luxiq PA  
betamethasone valerate ointment test  
desoximetasone 0.05% cream, ointment Topicort PA  
diflorasone cream PA  
fluocinonide / emollient test  
fluticasone ointment test  
triamcinolone 0.1% ointment, 0.5% cream test  

 Topical Corticosteroids – Class IV. Mid-Strength Potent

Drug Details

Drug Generic Name

Drug Brand Name

PA
Status

clocortolone cream Cloderm PA  
fluocinolone ointment Synalar # test  
fluocinolone ointment kit Synalar PA  
flurandrenolide ointment PA  
hydrocortisone valerate ointment test  
mometasone cream, solution Elocon # test  
triamcinolone 0.05% ointment PA  
triamcinolone 0.1% cream test  
triamcinolone spray Kenalog PA  

 Topical Corticosteroids – Class V. Lower Mid-Strength Potent

Drug Details

Drug Generic Name

Drug Brand Name

PA
Status

betamethasone valerate cream test  
desonide lotion, ointment test  
fluocinolone 0.01% cream test  
fluocinolone 0.025% cream Synalar # test  
fluocinolone cream kit Synalar PA  
fluocinolone shampoo Capex PA  
flurandrenolide cream, lotion PA  
fluticasone cream Cutivate # test  
fluticasone lotion Cutivate PA  
hydrocortisone butyrate / emollient test  
hydrocortisone butyrate cream, ointment, solution test  
hydrocortisone butyrate lotion PA  
hydrocortisone probutate cream Pandel PA  
hydrocortisone valerate cream test  
prednicarbate cream, ointment Dermatop # test  
triamcinolone 0.1% lotion, 0.025% ointment test  

 Topical Corticosteroids – Class VI. Mild Potent

Drug Details

Drug Generic Name

Drug Brand Name

PA
Status

alclometasone cream, ointment test  
betamethasone valerate lotion test  
desonide cream Desowen # test  
desonide gel Desonate PA  
fluocinolone body oil, scalp oil Derma-Smoothe-FS # test  
fluocinolone solution Synalar # test  
fluocinolone solution kit Synalar PA  
triamcinolone 0.025% cream, lotion test  

 Topical Corticosteroids – Class VII. Least Potent

Drug Details

Drug Generic Name

Drug Brand Name

PA
Status

hydrocortisone cream, lotion, ointment * test  
hydrocortisone solution PA  

 Topical Corticosteroids – Combination Products

Drug Details

Drug Generic Name

Drug Brand Name

PA
Status

betamethasone / calcipotriene foam Enstilar PA  
betamethasone / calcipotriene ointment, scalp suspension Taclonex PA  
halobetasol / tazarotene lotion Duobrii PA  
hydrocortisone / pramoxine foam test  
neomycin / fluocinolone cream, cream kit PA  
Table Footnotes
# This designates a brand-name drug with FDA “A”-rated generic equivalents. Prior authorization is required for the brand, unless a particular form of that drug (for example, tablet, capsule, or liquid) does not have an FDA “A”-rated generic equivalent.
 
* The generic OTC and, if any, generic prescription versions of the drug are payable under MassHealth without prior authorization.
 

II. Therapeutic Uses

FDA-approved, for example:

  • Corticosteroid-responsive dermatoses with secondary infection
  • Plaque psoriasis
  • Psoriasis vulgaris
  • Scalp-related conditions (i.e., dermatoses, psoriasis, seborrheic dermatitis)
  • Topical inflammatory and pruritic dermatoses

 Note: The above list may not include all FDA-approved indications.

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III.  Evaluation Criteria for Approval

 

 

 

Please note: In the case where the prior authorization (PA) status column indicates PA, both the brand and generic (if available) require PA. Typically, the generic is preferred when available unless the brand-name drug appears on the MassHealth Brand Name Preferred Over Generic Drug List. In general, when requesting the non-preferred version, whether the brand or generic, the prescriber must provide medical records documenting an inadequate response or adverse reaction to the preferred version, in addition to satisfying the criteria for the drug itself.

  • All PA requests must include clinical diagnosis, drug name, dose, and frequency.
  • A preferred drug may be designated for this therapeutic class. In general, MassHealth requires a trial of the preferred drug or clinical rationale for prescribing a non-preferred drug within a therapeutic class. Additional information about these agents, including PA requirements and preferred products, can be found within the MassHealth Drug List at www.mass.gov/druglist.
  • Additional criteria may apply, depending upon requested medication (see below).

 

amcinonide cream and ointment, clobetasol foam/emollient, gel, and lotion, clocortolone cream, desoximetasone, diflorasone cream and ointment, fluocinolone kit, fluocinonide 0.1% cream, flurandrenolide cream, lotion, and ointment, fluticasone lotion, halobetasol foam, hydrocortisone butyrate lotion, hydrocortisone solution, triamcinolone 0.05% ointment and spray, brand-name topical corticosteroids (Apexicon-E, Bryhali, Cordran tape, Desonate, Halog, Pandel, Sernivo, Ultravate lotion, Ultravate-X), and clobetasol foam and spray for non-scalp-related conditions

  • Documentation of all of the following is required:
    • an appropriate diagnosis; and
    • an adverse reaction or inadequate response to all generic topical corticosteroids of the same potency and dosage form; or
    •  
    • medical necessity for a specific dosage form.

  

betamethasone foam, Capex, and clobetasol foam, shampoo, shampoo kit, and spray for scalp-related conditions

  • Documentation of all of the following is required:
    • a scalp-related diagnosis; and
    • an adverse reaction or inadequate response to one generic topical corticosteroid of similar or greater potency and similar dosage form used on the scalp.

   

betamethasone/calcipotriene ointment and scalp suspension, Enstilar, and neomycin/fluocinolone cream and cream kit

  • Documentation of all of the following is required:        
    • an appropriate diagnosis; and
    • compelling clinical rationale why the combination product would offer a therapeutic advantage over the commercially available separate agents. 

 

clobetasol propionate powder

  • Documentation of all of the following is required:        
    • an appropriate diagnosis; and
    • clinical rationale why other commercially available alternatives cannot be used.

 

Duobrii (halobetasol/tazarotene lotion)

  • Documentation of all of the following is required:        
    • diagnosis of plaque psoriasis; and
    • an adverse reaction or inadequate response to one superpotent or potent topical corticosteroid; and
    • compelling clinical rationale why the combination product would offer a therapeutic advantage over the commercially available separate agents.


Original Effective Date: 10/2002

Last Revised Date: 07/2019


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Last updated 07/15/19