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    v1.0.30
    OpenPayerPolicy UpdatesPharmacy & Specialty DrugsAHCA Aemcolo Prior Auth Coverage Policy | OpenPaye…
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    CurrentAgency for Health Care AdministrationPolicy N/A

    Aemcolo (rifamycin) Prior Authorization Criteria

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    Establishes prior authorization criteria for Aemcolo (rifamycin) in adults with travelers' diarrhea caused by non-invasive Escherichia coli, including clinical eligibility, contraindications, coverage approval, and authorization duration.

    Policy Summary
    PayerAgency for Health Care Administration
    PolicyAemcolo (rifamycin) Prior Authorization Criteria
    Policy CodePolicy N/A
    Change TypeNo material clinical or coverage changes
    Effective DateN/A
    Next Review DateN/A
    Key ActionDocument that the patient is at least 18 years old and has non-invasive E. coli travelers' diarrhea without fever or bloody stools or relevant rifamycin hypersensitivity.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    3 daysAuthorization duration
    ≥18 yearsMinimum patient age
    194 mgTablet strength
    Non-invasive E. coliCovered etiology

    Coverage Criteria

    Policy Summary
    PayerAgency for Health Care Administration
    PolicyAemcolo (rifamycin) Prior Authorization Criteria
    Policy CodePolicy N/A
    Change TypeNo material clinical or coverage changes
    Effective DateN/A
    Next Review DateN/A
    Key ActionDocument that the patient is at least 18 years old and has non-invasive E. coli travelers' diarrhea without fever or bloody stools or relevant rifamycin hypersensitivity.
    SourceLink
    On This Page
    Coverage CriteriaProvider Actions and Denial RisksClinical BackgroundDefinitionsInitial Therapy Criteria

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    Initial Therapy

    Covered for initial therapy when ALL of the following are met:

    ALL of the following

    • Patient is 18 years of age or older.
    • Patient has known or strongly suspected travelers' diarrhea due to non-invasive strains of Escherichia coli (E. coli).
    • Diarrhea is not accompanied by fever or bloody stools.

    Coverage is excluded when the patient has known hypersensitivity to rifamycin, any other medication in the rifamycin class (including rifaximin), or any component of Aemcolo.

    Provider Actions and Denial Risks

    Prior Authorization

    Document Aemcolo clinical eligibility

    Prior authorization requires documentation that the patient is at least 18 years of age and has known or strongly suspected travelers' diarrhea due to non-invasive strains of Escherichia coli.

    • Document that the patient is ≥18 years of age.
    • Document known or strongly suspected travelers' diarrhea due to non-invasive E. coli.
    • Confirm that diarrhea is not accompanied by fever or bloody stools.
    Denial Risk

    Avoid clinical eligibility denials

    Coverage may be denied when the patient is younger than 18 years or has travelers' diarrhea that is not due to known or strongly suspected non-invasive Escherichia coli. Coverage may also be denied when diarrhea is accompanied by fever or bloody stools.

    • Patient must be ≥18 years of age.
    • Travelers' diarrhea must be due to known or strongly suspected non-invasive E. coli.
    • Diarrhea must not be accompanied by fever or bloody stools.
    Denial Risk

    Screen for hypersensitivity

    Coverage may be denied when the patient has known hypersensitivity to rifamycin, any other medication in the rifamycin class such as rifaximin, or any component of Aemcolo.

    • Check for hypersensitivity to rifamycin.
    • Check for hypersensitivity to another rifamycin-class medication, such as rifaximin.
    • Check for hypersensitivity to any Aemcolo component.

    Clinical Background

    Aemcolo (rifamycin) is evaluated for adults with travelers’ diarrhea caused by known or strongly suspected non-invasive strains of Escherichia coli. The policy distinguishes this eligible presentation from diarrhea accompanied by fever or bloody stools, which does not meet the coverage criteria.

    Definitions

    Eligible travelers' diarrhea
    InfectionTravelers' diarrhea caused by non-invasive strains of Escherichia coli (E. coli).
    Associated symptomsDiarrhea is not accompanied by fever or bloody stools.
    Patient populationAdults at least 18 years of age.

    Initial Therapy Criteria

    Initial Therapy Criteria

    Aemcolo is covered when all clinical requirements are met:

    Aemcolo initial therapy criteria

    • Patient is at least 18 years old.Age ≥18 years
    • Patient has known or strongly suspected travelers' diarrhea due to non-invasive Escherichia coli.
    • Diarrhea is not accompanied by fever or bloody stools.No fever or bloody stools
    • Patient has no known hypersensitivity to rifamycin, any other medication in the rifamycin class, including rifaximin, or any component of Aemcolo.