Topical Agents
Corticosteroids

Brand/Generic Name Dosage/Strength Status Restrictions Notes Relative Cost
Pediaderm HC
Hydrocortisone-Emollient		   notreimb.gif (545 bytes)  

Not Applicable

Key for Product(s) Listed Above
Formulary Prior Authorization (PA may not be required for some benefit plans) Non-Formulary
(Third tier coverage applies for selected plans)		 Not Reimbursed
Quantity Limit Not available through mail order as 90-day supply* Step Therapy Generic Available
Notes $Relative cost compared to others in category Specialty distribution for selected plans

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