Limited Coverage Drugs - Fidaxomicin
Generic Name / Strength / Form |
fidaxomicin / 200 mg / tablet |
Special Authority Criteria |
Approval Period |
For the treatment of confirmed severe Clostridium Difficile Infection (CDI)i:
Notes:
|
Up to 10 days for a single treatment course |
Practitioner Exemptions
- None
Special Notes
- Fidaxomicin should be used as monotherapy (i.e., not as an add-on).
- Requests for fidaxomicin in recurrent CDI will be considered in symptomatic patients that require treatment of a previously resolved CDI episode. This is defined as a subsequent CDI episode occurring within 2-8 weeks of a previous episode from the date of diagnosis.