Dificid (fidaxomicin) prior authorization — Coverage Criteria
Prior authorization requirements for Dificid (fidaxomicin) for treatment of C. difficile-associated diarrhea (CDAD) affecting adult and pediatric patients aged 6 months and older on the Neighborhood Health Plan/CVS Caremark formulary.
No material clinical or coverage changes in this revision.
Coverage Criteria for Dificid (fidaxomicin)
Initial Prior Authorization Coverage Criteria
Covered when ALL of the following are met
Required for prior authorization
Use of Dificid (fidaxomicin) is limited to infections that are proven or strongly suspected to be caused by C. difficile. The medication is not recommended for treatment of infections caused by other organisms. When available, culture and susceptibility data should be used to select or adjust therapy; if those data are not available, local epidemiology and susceptibility patterns may inform empiric antibiotic choice.
Provider Actions, Authorization & Documentation
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