Limited Coverage Drugs - Itraconazole

Generic Name Strength Form
itraconazole 100 mg capsule

 

Criteria

Approval Period

1. Immunocompromised patients.

1. Indefinite

OR

2. Pulse treatment for severe onychomycosis with functional disability
PLUS
confirmed lab results for candida or dermatophyte infection.

2. Three months

Practitioner Exemptions

  • Physicians specializing in treatment of HIV/AIDS patients

Special Notes

  • None

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