To order additional copies, please call Massachusetts Medical

Dermatologic Agents (Steroids — High Potency)
Name AETNA BCBSMA BMCHP FCHP HPHC HNE NHP NTWK MAHLTH THP
FLUOCINONIDE 0 .05% cream, gel, X* X* X X X X X X X X
ointment, solution
FLUOCINONIDE EMOLLIENT BAsE X* X* X X X X X X X
0 .05% cream
HALCINONIDE 0 .1% cream, FE X X X PA X
ointment, solution [Halog]
TRIAMCINOLONE ACETONIDE X* X* X X X X X X X X
cream, ointment, lotion
Dermatologic Agents (Steroids — Very High Potency)
AUgMENTED BETAMETHAsONE X* X* X X X X X X X X
DIPROPIONATE 0 .05% ointment
AUgMENTED BETAMETHAsONE
DIPROPIONATE 0 .05% gel, lotion,
ointment [Diprolene]
FE X PA X NC PA X
CLOBETAsOL PROPIONATE 0 .05% X* X* X X X X X X X X
CLOBETAsOL PROPIONATE lotion, X* X PA X sT PA PA X1 shampoo, spray [Clobex]
CLOBETAsOL [Cormax] X* X X X X PA X
CLOBETAsOL PROPIONATE 0 .05%
[Olux]
FE sT NC PA PA X PA PA X
CLOBETAsOL PROPIONATE 0 .05%
emollient [Olux-E]
FE sT NC PA PA X PA NC
CLOBETAsOL PROPIONATE 0 .05%
[Temovate]
X X PA X NC PA X
DIFLORAsONE DIACETATE 0 .05%
ointment
X* X* X X X X X X X X
DIFLORAsONE DIACETATE
[Apexicon]
X X X X NC X
DIFLORAsONE DIACETATE
[Psorcon]
X PA X NC PA X
FLUOCINONIDE 0 .1% [Vanos] X* NC PA X PA PA X
HALOBETAsOL PROPIONATE 0 .05% X* X* X X X X X X X X
HALOBETAsOL PROPIONATE
[Ultravate]
FE X PA X NC PA X
Diabetes Management (Insulin/Other)
EXENATIDE [Byetta] DL* X* X sT sT DL sT X PA X*
INsULIN AsPART [Novolog prefilled] X* X* X X X X X PA X
1 Clobex spray NC
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