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Table 16: Corticosteroids - Topical


A    B    C    D    E    F    G    H    I    J    K    L    M    N    O    P    Q    R    S    T    U    V    W    X    Y    Z


Drug Category: Dermatological

Medication Class/Individual Agents: Corticosteroids

I. Prior-Authorization Requirements

 Topical Corticosteroids – Class I. Superpotent

Clinical Notes

Drug Details

Drug Generic Name

Drug Brand Name

PA
Status

Drug
Notes

betamethasone augmented gel test   A90
betamethasone dipropionate lotion, ointment test   A90
betamethasone dipropionate, augmented ointment Diprolene test   # , A90
clobetasol propionate cream / emollient test   A90
clobetasol propionate cream, ointment Temovate test   # , A90
clobetasol propionate foam Olux test   # , A90
clobetasol propionate foam / emollient Olux-E PA   A90
clobetasol propionate gel, shampoo kit PA   A90
clobetasol propionate lotion, spray-Clobex Clobex test   # , A90
clobetasol propionate lotion-Impeklo Impeklo PA  
clobetasol propionate powder PA  
clobetasol propionate shampoo Clobex PA   A90
clobetasol propionate solution test   A90
diflorasone ointment PA   A90
fluocinonide 0.1% cream Vanos test   # , A90
halobetasol cream, ointment test   A90
halobetasol foam Lexette PA   A90
halobetasol lotion Bryhali PA  
halobetasol lotion Ultravate PA   A90

Please note: In the case where the prior authorization (PA) status column indicates PA, both the brand and generic (if available) require PA. Typically, the generic is preferred when available unless the brand-name drug appears on the MassHealth Brand Name Preferred Over Generic Drug List. In general, when requesting the non-preferred version, whether the brand or generic, the prescriber must provide medical records documenting an inadequate response or adverse reaction to the preferred version, in addition to satisfying the criteria for the drug itself.

 

Product Potency:

  • Relative potency of a product depends on the characteristics and concentration of the drug and the vehicle. 
  • Generally, ointments and gels are more potent than creams or lotions; however, some products have been formulated to yield comparable potency.

Product Selection:

  • Selection of a specific corticosteroid, strength, and vehicle depends on the nature, location, and extent of the skin condition, patient’s age, and anticipated duration of treatment.
  • Use the least-potent corticosteroid that would be effective.
  • Low-potency agents are preferred for the face, intertriginous areas (e.g., groin, axilla), and large areas to reduce the potential for side effects.
  • Low-potency agents are preferred in children.
  • Reserve higher-potency agents for areas and conditions resistant to treatment with milder agents.

Adverse Reactions:

  • Systemic absorption of topical corticosteroids has produced reversible hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing’s syndrome, hyperglycemia, and glycosuria.
  • Conditions that augment systemic absorption include application of more-potent steroids, use over large surface areas, prolonged use, addition of occlusive dressings, and patient’s age.
  • Perform appropriate clinical and laboratory tests if a topical corticosteroid is used for long periods or over large areas of the body.

With chronic conditions, gradual discontinuation of therapy may reduce the chance of rebound.

 

 Topical Corticosteroids – Class II. Potent

Drug Details

Drug Generic Name

Drug Brand Name

PA
Status

Drug
Notes

betamethasone dipropionate cream test   A90
betamethasone dipropionate powder PA   A90
betamethasone dipropionate spray Sernivo PA  
betamethasone dipropionate, augmented cream, lotion test   A90
desoximetasone 0.25% cream test   A90
desoximetasone 0.25% ointment, spray, 0.05% gel Topicort PA   A90
diflorasone cream / emollient Apexicon-E PA   A90
fluocinonide cream, gel, ointment, solution test   A90
halcinonide cream, solution Halog PA   A90
halcinonide ointment Halog test  
mometasone ointment test   A90
triamcinolone 0.5% ointment test   A90

 Topical Corticosteroids – Class III. Upper Mid-Strength Potent

Drug Details

Drug Generic Name

Drug Brand Name

PA
Status

Drug
Notes

amcinonide cream, lotion PA   A90
betamethasone valerate foam Luxiq test   # , A90
betamethasone valerate ointment test   A90
desoximetasone 0.05% cream, ointment Topicort PA   A90
diflorasone cream PA   A90
fluocinonide / emollient test   A90
fluticasone ointment test   A90
triamcinolone 0.1% ointment, 0.5% cream test   A90

 Topical Corticosteroids – Class IV. Mid-Strength Potent

Drug Details

Drug Generic Name

Drug Brand Name

PA
Status

Drug
Notes

clocortolone cream Cloderm PA   A90
fluocinolone ointment Synalar test   # , A90
fluocinolone ointment kit Synalar PA  
flurandrenolide ointment PA   A90
hydrocortisone valerate ointment PA   A90
mometasone cream, solution test   A90
triamcinolone 0.05% ointment PA   A90
triamcinolone 0.1% cream test   A90
triamcinolone spray Kenalog PA   A90

 Topical Corticosteroids – Class V. Lower Mid-Strength Potent

Drug Details

Drug Generic Name

Drug Brand Name

PA
Status

Drug
Notes

betamethasone valerate cream test   A90
desonide lotion PA   A90
desonide ointment test   A90
fluocinolone 0.01% cream test   A90
fluocinolone 0.025% cream Synalar test   # , A90
fluocinolone cream kit Synalar PA  
fluocinolone shampoo Capex test  
flurandrenolide cream, lotion PA   A90
fluticasone cream Cutivate test   # , A90
fluticasone lotion Cutivate PA   A90
hydrocortisone butyrate / emollient Locoid Lipocream PA   A90
hydrocortisone butyrate cream, ointment, solution test   A90
hydrocortisone butyrate lotion Locoid PA   A90
hydrocortisone probutate cream Pandel test  
hydrocortisone valerate cream test   A90
prednicarbate cream, ointment test   A90
triamcinolone 0.1% lotion, 0.025% ointment test   A90

 Topical Corticosteroids – Class VI. Mild Potent

Drug Details

Drug Generic Name

Drug Brand Name

PA
Status

Drug
Notes

alclometasone cream, ointment test   A90
betamethasone valerate lotion test   A90
desonide cream Desowen test   # , A90
desonide gel Desonate PA   A90
fluocinolone body oil, scalp oil Derma-Smoothe-FS test   # , A90
fluocinolone solution Synalar test   # , A90
fluocinolone solution kit Synalar PA  
triamcinolone 0.025% cream, lotion test   A90

 Topical Corticosteroids – Class VII. Least Potent

Drug Details

Drug Generic Name

Drug Brand Name

PA
Status

Drug
Notes

hydrocortisone cream, lotion, ointment test   *, A90
hydrocortisone solution PA   A90

 Topical Corticosteroids – Combination Products

Drug Details

Drug Generic Name

Drug Brand Name

PA
Status

Drug
Notes

betamethasone / calcipotriene foam Enstilar PA  
betamethasone / calcipotriene ointment Taclonex PA   A90
betamethasone / calcipotriene scalp suspension Taclonex PA   BP, A90
halobetasol / tazarotene lotion Duobrii PA  
hydrocortisone / pramoxine foam test   A90
neomycin / fluocinolone cream, cream kit PA   A90

 Topical Corticosteroids – Dental Agents

Drug Details

Drug Generic Name

Drug Brand Name

PA
Status

Drug
Notes

triamcinolone paste test   A90
Table Footnotes
# This designates a brand-name drug with FDA “A”-rated generic equivalents. Prior authorization is required for the brand, unless a particular form of that drug (for example, tablet, capsule, or liquid) does not have an FDA “A”-rated generic equivalent.
 
BP Brand Preferred over generic equivalents. In general, MassHealth requires a trial of the preferred drug or clinical rationale for prescribing the non-preferred drug generic equivalent.
 
* The generic OTC and, if any, generic prescription versions of the drug are payable under MassHealth without prior authorization.
 
A90 Allowable 90-day supply. Dispensing in up to a 90-day supply is allowed. May not include all strengths or formulations. Quantity limits and other restrictions may apply.
 

II. Therapeutic Uses

FDA-approved, for example:

  • Corticosteroid-responsive dermatoses with secondary infection
  • Plaque psoriasis
  • Psoriasis vulgaris
  • Scalp-related conditions (i.e., dermatoses, psoriasis, seborrheic dermatitis)
  • Topical inflammatory and pruritic dermatoses

 Note: The above list may not include all FDA-approved indications.

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III.  Evaluation Criteria for Approval

Please note: In the case where the prior authorization (PA) status column indicates PA, both the brand and generic (if available) require PA. Typically, the generic is preferred when available unless the brand-name drug appears on the MassHealth Brand Name Preferred Over Generic Drug List. In general, when requesting the non-preferred version, whether the brand or generic, the prescriber must provide medical records documenting an inadequate response or adverse reaction to the preferred version, in addition to satisfying the criteria for the drug itself.

  • All PA requests must include clinical diagnosis, drug name, dose, and frequency.
  • Dispensing in a 90-day supply of medication may be mandated or allowable for agents in this therapeutic class (designated by M90 or A90, respectively, in the Drug Notes section above). Applicable quantity limits are described below as units per day, per month, per 28 days, or as clinically appropriate, and may be extrapolated for fills of longer day supply. 
  • A preferred drug may be designated for this therapeutic class. In general, MassHealth requires a trial of the preferred drug or clinical rationale for prescribing a non-preferred drug within a therapeutic class. Additional information about these agents, including PA requirements and preferred products, can be found within the MassHealth Drug List at www.mass.gov/druglist.
  • For recertification requests, approval may require submission of additional documentation including, but not limited to, documentation of: some or all criteria for the original approval; response to therapy; clinical rationale for continuation of use; status of member’s condition; appropriate diagnosis; appropriate age; appropriate dose, frequency, and duration of use for requested medication; complete treatment plan; current laboratory values; and member’s current weight.
  • Additional criteria may apply, depending upon requested medication (see below).

 

amcinonide cream and lotion, clobetasol foam/emollient and gel, clocortolone cream, desonide lotion, desoximetasone 0.05% cream, gel, and ointment, desoximetasone 0.25% ointment and spray, diflorasone cream and ointment, fluocinolone kit, flurandrenolide cream, lotion, and ointment, fluticasone lotion, halcinonide cream, halobetasol foam, hydrocortisone butyrate lotion, hydrocortisone butyrate/emollient cream, hydrocortisone solution, hydrocortisone valerate ointment, triamcinolone 0.05% ointment and spray, and brand-name topical corticosteroids (Apexicon-E, Bryhali, Desonate, Halog solution, Sernivo, Ultravate lotion).

  • Documentation of all of the following is required:
    • an appropriate diagnosis; and
    • one of the following:
      • an adverse reaction or inadequate response to all topical corticosteroids of the same potency range and dosage form available without prior authorization; or
      • medical necessity for a specific dosage form.

  

betamethasone/calcipotriene ointment and scalp suspension, Enstilar, and neomycin/fluocinolone cream and cream kit

  • Documentation of all of the following is required:        
    • an appropriate diagnosis; and
    • compelling clinical rationale why the combination product would offer a therapeutic advantage over the commercially available separate agents. 

 

betamethasone dipropionate powder and clobetasol propionate powder

  • Documentation of all of the following is required:        
    • an appropriate diagnosis; and
    • clinical rationale why other commercially available alternatives cannot be used.

 

clobetasol shampoo and shampoo kit for scalp-related conditions

  • Documentation of all of the following is required:
    • a scalp-related diagnosis; and
    • an adverse reaction or inadequate response to one topical corticosteroid of similar or greater potency and similar dosage form available without prior authorization and used on the scalp.

 

Duobrii (halobetasol/tazarotene lotion)

  • Documentation of all of the following is required:        
    • diagnosis of plaque psoriasis; and
    • an adverse reaction or inadequate response to one superpotent or potent topical corticosteroid available without prior authorization; and
    • compelling clinical rationale why the combination product would offer a therapeutic advantage over the commercially available separate agents.

    

Impeklo (clobetasol propionate lotion)

  • Documentation of all of the following is required:
    • an appropriate diagnosis; and
    • member is ≥ 18 years of age; and
    • one of the following:
      • an adverse reaction or inadequate response to all topical corticosteroids of the same potency range and dosage form available without prior authorization; or
      • medical necessity for a specific dosage form; and
    • medical records documenting an inadequate response or adverse reaction to clobetasol propionate lotion (Clobex). 


Original Effective Date: 10/2002

Last Revised Date: 09/2022


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Last updated 10/31/22

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