Limited Coverage Drugs - Aztreonam
Generic Name |
aztreonam |
Strength |
|
Form | Vial-Neb |
Special Authority Criteria |
Approval Period |
For the cyclic treatment of chronic Pseudomonas aeruginosa infections in patients with: Moderate to severe cystic fibrosis AND A deteriorating clinical condition despite treatment with inhaled tobramycin. |
Indefinite |
Practitioner Exemptions
- None
Special Notes
- Cyclic treatment is measured in 28-day cycles and is defined as 28 days “on” aztreonam followed by 28 days “off.”
- Aztreonam may be prescribed either as monotherapy or as a combination treatment with another therapy chosen by the prescribing physician.
- Aztreonam is a PharmaCare high-cost drug. PharmaCare reimburses high-cost drugs eligible for coverage to a maximum price based on the manufacturer list price plus a 5 percent mark-up.