CurrentColorado Rocky Mountain Health PlansPolicy 2025 P 1369-4

Prior authorization/notification for Stromectol (ivermectin) oral

Prior authorization and notification requirements for oral ivermectin (Stromectol) for treatment of parasitic infections; affects prescribers and pharmacy benefit adjudication for members covered by the payer.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyPrior authorization/notification for Stromectol (ivermectin) oral

Policy CodePolicy 2025 P 1369-4

Change TypeRevision with background and reference updatesoriginal program creation noted

Effective DateJun 1, 2025

Next Review Date

Key ActionObtain prior authorization/notification for Stromectol (ivermectin) — authorizations are issued for 1 month.

SourceLink

POLICY UPDATE CHANGES

Program created as a prior authorization/notification requirement for Stromectol (ivermectin).

Updated references and background with FDA reference.

Updated references, added state mandate footnote, revised background language to align with NIH reference.

9listed covered indications (a-i)

2025-06-01effective date

1 monthauthorization duration issued

3/2025last P&T approval date

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Coverage Criteria

Initial Authorization Indications

Covered when ANY of the following diagnoses are present:

Covered Indications (a-i): a. Onchocerciasis due to nematode parasite; b. Pediculosis; c. Strongyloidiasis; d. Ascariasis; e. Scabies (including crusted scabies); f. Cutaneous larva migrans (hook worm disease); g. Enterobiasis; h. Filariasis; i. Trichuriasis

Authorization will be issued for 1 month. State mandates and member-specific benefit plan coverage may impact coverage.

Use of oral ivermectin for COVID-19 is not supported by available clinical trial data. The U.S. Food and Drug Administration has determined that currently available clinical trial data do not demonstrate that ivermectin is effective against COVID-19 in humans. Clinical guidance from major public health authorities similarly does not endorse ivermectin for prevention or treatment of COVID-19; prescribers should rely on approved and guideline-supported therapies for SARS-CoV-2 infection.

This policy addresses coverage and prior-authorization requirements for Stromectol (ivermectin) oral for parasitic infections and does not authorize use of ivermectin for COVID-19. Any request for ivermectin to treat COVID-19 should be evaluated against current FDA and NIH guidance and will not be supported by this coverage criterion in the absence of high-quality evidence demonstrating benefit.

Initial Therapy Notes

Initial therapy notes

Typical dosing and general use

Dosing note: Most infections are treated with a single weight-based dose.

Provider Actions & Authorization Rules

Prior Authorization

Prior Authorization Required

Prior authorization is required for oral ivermectin (Stromectol). Authorizations will be issued for 1 month. State mandates, federal regulatory requirements, and the member's specific benefit plan coverage may affect coverage and authorization decisions. Other policies and utilization management programs may also apply.

Authorization duration: 1 month
Affected product: Stromectol® (ivermectin) oral dosage form
Prior authorization/notification required

Step Therapy

Step Therapy / Supply Limits

Supply limits, Medical Necessity determinations, and/or Step Therapy may apply and could affect approval. Specific step requirements or supply restrictions may be enforced per the member's plan or program rules.

Supply limits may be imposed
Step therapy may be required

Step Therapy

Step	Requirement / Note
1	Step therapy may be in place but no specific steps are defined in this document.

Quantity Limits

Stromectol (ivermectin) oral — Quantity / Supply Limits

Quantity limit summaryAuthorizations are issued for 1 month; supply limits may apply per utilization management rules.

Supply limit sourceSupply limits and Medical Necessity or Step Therapy may be in place as an additional clinical rule.

Automated approval impactApprovals and reauthorizations may be granted based on previous claim/medication history, diagnosis codes (ICD-10), and/or claim logic which can affect quantity dispensed.

State and plan effectsState mandates, federal regulatory requirements, and member-specific benefit plans may impact coverage and any supply/quantity limits.

Site of Care

Note

No specific site-of-care restrictions

No site-of-care restrictions are specified for oral ivermectin in this policy; home administration is noted as the setting.

Background

Ivermectin (oral) is an antiparasitic (antihelminthic) agent indicated for treatment of parasitic infections such as strongyloidiasis and onchocerciasis. It may also be used for other compendia-supported parasitic infections including scabies (including crusted scabies), hookworm disease (cutaneous larva migrans), ascariasis, enterobiasis, filariasis, trichuriasis, and pediculosis.

Most of these infections are managed with a single weight-based dose. This policy establishes prior authorization and notification requirements for oral ivermectin (Stromectol) for covered parasitic indications and does not alter usual clinical dosing practices; authorizations issued under this program are generally for 1 month.

Definitions

Ivermectin (oral) — Definition

Generic definitionIvermectin (oral dosage form): antiparasitic agent indicated for treatment of strongyloidiasis and onchocerciasis; may be used for other compendia-supported parasitic infections.

Common additional indicationsIncludes compendia-supported uses such as scabies (including crusted scabies), hookworm disease (cutaneous larva migrans), and ascariasis.

Dosing noteMost infections are treated with a single weight-based dose.

COVID-19 statementFDA has determined current clinical trial data do not demonstrate ivermectin is effective against COVID-19 in humans.