Limited Coverage Drugs - Special Authority Criteria

Generic Name / Strength / Form
tretinoin topical

Criteria Approval Period
1. Diagnosis of acne.

OR

2. Diagnosis of skin cancer.

 Indefinite

Practitioner Exemptions

  • No practitioner exemptions

Special Notes

  • Tretinoin topical for cosmetic indications is not eligible for PharmaCare coverage.

Online Forms (PDF)
Click on the link to complete a special authority request form.