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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

Last Modified on Nov 10, 2020

Oklahoma Health Care Authority

4345 N Lincoln Blvd

Oklahoma City, OK 73105

The Oklahoma Health Care Authority collects the personally identifiable data submitted and received in regard to applications for services, renewals, appeals, provision of health care and processing of claims. This data is treated as confidential and is stored securely in accordance with applicable law and regulations. OHCA may share this personally identifiable data with its authorized business associates, government agencies with jurisdiction over the OHCA, or as otherwise required or permitted by applicable law.