Dermatology Medications and Treatment
Pharmaceutical Products
Product
Size
ManufacturerMfgr
NDC#
Code*
RNI
340B
Acne Vulgaris
Size: (1.2%/0.025%) 30 gm
Manufacturer: Prasco Laboratories
NDC#: 66993-0959-31
Code*: J3490
RNINo
340BNo
Size: (1.2%/0.025%) 60 gm
Manufacturer: Prasco Laboratories
NDC#: 66993-0959-61
Code*: J3490
RNINo
340BNo
Manufacturer: Galderma
NDC#: 00299-5912-02
Code*: TBD
RNITBD
340BYes
Manufacturer: Galderma
NDC#: 00299-5945-30
Code*: TBD
RNINo
340BNo
Dermatosis
Melasma
Manufacturer: Galderma
NDC#: 00299-5950-30
Code*: TBD
RNITBD
340BYes
Molluscum Contagiosum
Onychomycosis
Plaque Psoriasis
Manufacturer: UCB
NDC#: 50474-0710-79
Code*: J0717
RNINo
340BYes
Manufacturer: UCB
NDC#: 50474-0710-81
Code*: J0717
RNINo
340BYes
Manufacturer: UCB
NDC#: 50474-0700-62
Code*: J0717
RNINo
340BYes
Manufacturer: Galderma
NDC#: 00299-3849-04
Code*: TBD
RNITBD
340BYes
Manufacturer: Mayne Pharma
NDC#: 51862-0604-50
Code*: J3490
RNINo
340BNo
Manufacturer: Mayne Pharma
NDC#: 51862-0376-12
Code*: TBD
RNINo
340BNo
Size: 60 gm Laminated Tube
Manufacturer: Dermavant Sciences
NDC#: 81672-5051-01
Code*: TBD
RNINo
340BNo
Rosacea
Manufacturer: Galderma
NDC#: 00299-3822-30
Code*: TBD
RNITBD
340BYes
Severe Acne
Manufacturer: Mayne Pharma
NDC#: 51862-0571-30
Code*: TBD
RNINo
340BNo
Manufacturer: Mayne Pharma
NDC#: 68308-0716-30
Code*: TBD
RNINo
340BNo
Size: 10 mg Capsules Box of 30
Manufacturer: Mayne Pharma
NDC#: 68308-0570-30
Code*: J8499
RNINo
340BNo
Size: 20 mg Capsules Box of 30
Manufacturer: Mayne Pharma
NDC#: 68308-0571-30
Code*: J8499
RNINo
340BNo
Size: 30 mg Capsules Box of 30
Manufacturer: Mayne Pharma
NDC#: 68308-0573-30
Code*: J8499
RNINo
340BNo
Size: 40 mg Capsules Box of 30
Manufacturer: Mayne Pharma
NDC#: 68308-0575-30
Code*: J8499
RNINo
340BNo
Scalp Psoriasis
Skin Treatments
Product: Cetaphil® Dermacontrol Oil Absorbing Moisturizer (w/ Sunscreen SPF 30) 2
Prescribing Information
Prescribing Information
Size: 4 oz
Manufacturer: Galderma
NDC#: 00299-4313-04
Code*: TBD
RNITBD
340BNo
* All codes should be verified between the provider and the payer.
1 Call for eligibility through your GPO affiliation.
2 Call for eligibility.
1 Call for eligibility through your GPO affiliation.
2 Call for eligibility.