Dermatology Medications and Treatment

Pharmaceutical Products

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Product
Size
ManufacturerMfgr
NDC#
Code*
RNI
340B
Acne Vulgaris
Product: Adapalene and Benzoyl Peroxide Gel 0.3%/2.5% 2
Prescribing Information
Size: 45 gm Pump
Manufacturer: TEVA
NDC#: 00093-6303-45
Code*: J3490
RNITBD
340BNo
Product: AKLIEF® Cream 2
Prescribing Information
Size: 45 gm Pump
Manufacturer: Galderma
NDC#: 00299-5935-45
Code*: J3490
RNITBD
340BYes
Product: Clindamycin Phosphate and Tretinoin Gel
Prescribing Information
Size: (1.2%/0.025%) 30 gm
Manufacturer: Prasco Laboratories
NDC#: 66993-0959-31
Code*: J3490
RNINo
340BNo
Product: Clindamycin Phosphate and Tretinoin Gel
Prescribing Information
Size: (1.2%/0.025%) 60 gm
Manufacturer: Prasco Laboratories
NDC#: 66993-0959-61
Code*: J3490
RNINo
340BNo
Product: DIFFERIN® Lotion 0.1% 2
Prescribing Information
Size: 2 fl oz (59 mL) Pump Bottle
Manufacturer: Galderma
NDC#: 00299-5912-02
Code*: TBD
RNITBD
340BYes
Product: DIFFERIN® Cream 0.1% 2
Prescribing Information
Size: 45 gm Tube
Manufacturer: Galderma
NDC#: 00299-5915-45
Code*: TBD
RNITBD
340BYes
Product: DIFFERIN® Gel 0.3% 2
Prescribing Information
Size: 45 gm Pump
Manufacturer: Galderma
NDC#: 00299-5918-25
Code*: TBD
RNITBD
340BYes
Product: EPIDUO® FORTE Gel 2
Prescribing Information
Size: 45 gm Pump
Manufacturer: Galderma
NDC#: 00299-5906-45
Code*: TBD
RNITBD
340BYes
Product: TWYNEO® Cream 1
Prescribing Information
Size: 30 gm Bottle w/ Pump (0.1%/3%)
Manufacturer: Galderma
NDC#: 00299-5945-30
Code*: TBD
RNINo
340BNo
Dermatosis
Product: CLOBEX® Lotion 0.05% 2
Prescribing Information
Size: 4 fl oz (118 mL) Bottle
Manufacturer: Galderma
NDC#: 00299-3848-04
Code*: TBD
RNITBD
340BYes
Melasma
Product: TRI-LUMA® Cream 2
Prescribing Information
Size: 30 gm Aluminum Tube (0.01%/4%/0.05%)
Manufacturer: Galderma
NDC#: 00299-5950-30
Code*: TBD
RNITBD
340BYes
Plaque Psoriasis
Product: CIMZIA®
Prescribing Information
Size: 200 mg Single-dose Pre-filled Syringe
Manufacturer: UCB
NDC#: 50474-0710-79
Code*: J0717
RNINo
340BYes
Product: CIMZIA®
Prescribing Information
Size: 200 mg Single-dose Pre-filled Syringe Pack of 6
Manufacturer: UCB
NDC#: 50474-0710-81
Code*: J0717
RNINo
340BYes
Product: CIMZIA®
Prescribing Information
Size: 200 mg Single-dose Vial
Manufacturer: UCB
NDC#: 50474-0700-62
Code*: J0717
RNINo
340BYes
Product: CLOBEX® Spray 0.05% 2
Prescribing Information
Size: 4.25 fl oz (125 mL) Bottle
Manufacturer: Galderma
NDC#: 00299-3849-04
Code*: TBD
RNITBD
340BYes
Product: VECTICAL® Ointment 2
Prescribing Information
Size: 3 mcg/1 gm 100 gm Tube
Manufacturer: Galderma
NDC#: 00299-2012-10
Code*: TBD
RNITBD
340BYes
Product: VTAMA® Cream 1%
Prescribing Information
Size: 60 gm Laminated Tube
Manufacturer: Dermavant Sciences
NDC#: 81672-5051-01
Code*: TBD
RNINo
340BNo
Rosacea
Product: EPSOLAY® Cream 5% 2
Prescribing Information
Size: 30 gm Pump
Manufacturer: Galderma
NDC#: 00299-5890-30
Code*: TBD
RNINo
340BNo
Product: Ivermectin Cream 1%
Prescribing Information
Size: 45 gm Tube
Manufacturer: Padagis
NDC#: 00574-2107-45
Code*: TBD
RNINo
340BNo
Product: MIRVASO® Gel 0.33% 2
Prescribing Information
Size: 30 gm Pump
Manufacturer: Galderma
NDC#: 00299-5980-35
Code*: J3490
RNINo
340BYes
Product: ORACEA® 2
Prescribing Information
Size: 40 mg Capsule Bottle of 30
Manufacturer: Galderma
NDC#: 00299-3822-30
Code*: TBD
RNITBD
340BYes
Product: SOOLANTRA® Cream 2
Prescribing Information
Size: 45 gm Tube
Manufacturer: Galderma
NDC#: 00299-3823-45
Code*: TBD
RNITBD
340BYes
Scalp Psoriasis
Product: CLOBEX® Shampoo 0.05% 2
Prescribing Information
Size: 4 fl oz (118 mL) Bottle
Manufacturer: Galderma
NDC#: 00299-3847-04
Code*: TBD
RNITBD
340BYes
Skin Treatments
Product: Cetaphil® Moisturizing Lotion 2
Prescribing Information
Size: 4 oz
Manufacturer: Galderma
NDC#: 00299-0241-31
Code*: TBD
RNITBD
340BNo
Product: Cetaphil® Gentle Cleanser 2
Prescribing Information
Size: 4 oz
Manufacturer: Galderma
NDC#: 00299-0110-24
Code*: TBD
RNITBD
340BNo
Product: Cetaphil® Daily Facial Cleanser 2
Prescribing Information
Size: 4 oz
Manufacturer: Galderma
NDC#: 00299-3927-38
Code*: TBD
RNITBD
340BNo
Product: Cetaphil® Sheer Mineral Sunscreen Stick SPF 50 (Broad Spectrum) 2
Prescribing Information
Size: 0.5 oz
Manufacturer: Galderma
NDC#: 00299-4108-00
Code*: TBD
RNITBD
340BNo
Product: Cetaphil® Sheer Mineral Sunscreen SPF 50 (Broad Spectrum) 2
Prescribing Information
Size: 1 oz
Manufacturer: Galderma
NDC#: 00299-4110-00
Code*: TBD
RNITBD
340BNo
Product: Cetaphil® Sheer Mineral Sunscreen SPF 50 (Broad Spectrum) 2
Prescribing Information
Size: 3 oz
Manufacturer: Galderma
NDC#: 00299-4122-00
Code*: TBD
RNITBD
340BNo
Product: Cetaphil® Moisturizing Cream 2
Prescribing Information
Size: 3 oz
Manufacturer: Galderma
NDC#: 00299-3917-53
Code*: TBD
RNITBD
340BNo
Product: Cetaphil® Dermacontrol Oil Absorbing Moisturizer (w/ Sunscreen SPF 30) 2
Prescribing Information
Size: 4 oz
Manufacturer: Galderma
NDC#: 00299-4313-04
Code*: TBD
RNITBD
340BNo
Product: Cetaphil® Gentle Cleansing Cloths 2
Prescribing Information
Size: 25 Count
Manufacturer: Galderma
NDC#: 00299-3934-56
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.
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