Standard Health Pals Formulary
Clobetasol Propionate 0.05% Shampoo (Generic for Clobex)
Coverage Level – 100%
Copay – $0
Limitations – No more than 90 days’ supply; Maximum 120 ml in 30 days; Maximum 360 ml in 90 days
Restrictions – Health Pals Mail Order Pharmacy Network
Comments – Generic for Clobex