Standard Health Pals Formulary
Diflorasone Ointment 0.05% (Generic for Psorcon)
Coverage Level – 100%
Copay – $0
Limitations – No more than 90 days’ supply; Maximum 30 grams in 30 days; Maximum 90 grams in 90 days
Restrictions – Health Pals Mail Order Pharmacy Network
Comments – Generic for Psorcon