Standard Health Pals Formulary
Adapalene 0.1% / Benzoyl Peroxide 2.5% Gel (Generic for Epiduo)
Coverage Level – 100%
Copay – $0
Limitations – No more than 30 days’ supply; Maximum 45 grams in 30 days
Restrictions – Health Pals Mail Order Pharmacy Network
Comments – Generic for Epiduo