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
Plaque Psoriasis
Manufacturer: UCB
NDC#: 50474-0710-79
Code*: J0717
RNINo
340BYes
Manufacturer: UCB
NDC#: 50474-0710-81
Code*: J0717
RNINo
340BYes
Manufacturer: Galderma
NDC#: 00299-3849-04
Code*: TBD
RNITBD
340BYes
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
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.