Daraprim Pa Policy 1341 A 01 2022
Prior authorization criteria for Daraprim (pyrimethamine) covering treatment and prophylaxis indications (toxoplasmosis, Pneumocystis jirovecii pneumonia prophylaxis, cystoisosporiasis) when sulfamethoxazole/trimethoprim intolerance or contraindication exists and for certain CD4 thresholds; applies to initial prior authorization per CVS Caremark criteria.
No material clinical/coverage changes
Coverage Summary
Prior authorization is required. Daraprim (pyrimethamine) is covered with criteria for treatment and prophylaxis of toxoplasmosis (including congenital toxoplasmosis in pediatric patients and secondary prophylaxis), prophylaxis for Pneumocystis jirovecii pneumonia (PJP), and treatment/secondary prophylaxis of cystoisosporiasis. Compendial uses include prophylaxis for toxoplasmosis and PJP and treatment/secondary prophylaxis of cystoisosporiasis, and Daraprim is indicated for treatment of toxoplasmosis when used with a sulfonamide.
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