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

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