will apply to all services performed on or after the above revision date which
will become the new effective date.
services referred to in this policy that were performed before the revision
date, contact customer service for the rules that would apply.
Ketoconazole tablets require prior authorization.
Food and Drug Administration (FDA) has limited the usage of Ketoconazole tablets
due to potentially fatal liver injury, risk of drug interactions, and adrenal
Ketoconazole tablets are covered under the pharmacy benefit.