Pediculicide Products

PHARM-13 Statement of Medical Necessity for Quantity Limits Override.

Pediculicide Products

Drugs

Quantity Limits

Eurax (Crotamiton) 10 % Cream 

60 gms per 30 Days

Eurax (Crotamiton) 10 % Lotion 

60 mls per 30 Days

Eurax (Crotamiton) 10 % Suspension 

60 mls per 30 Days

Lindane 1% Lotion 

60 mls per 7 Days

Lindane 1% Shampoo

60 mls per 7 Days

Ovide (Malathion) 0.5% Lotion 

59 mls per 7 Days

Permethrin 1% Liquid 

120 - 240 mls per 7 Days

Permethrin 5% Cream 

60 gms per 7 Days

Ulesfia (Benzyl Alcohol) 5% Topical Lotion 

908 mls per 30 days