Limited Coverage Drugs - Vancomycin
Generic Name |
vancomycin |
---|---|
Strength |
125 mg, 250 mg |
Form | capsule |
Special Authority Criteria |
Approval Period |
---|---|
For the treatment of symptomatic Clostridium Difficile Infection (CDI), when:
|
Initial: up to 14 days Second or further recurrence: up to 14 days |
Practitioner Exemptions
- None
Special Notes
- Vancomycin capsules are a full benefit for patients registered with the Palliative program.
- Prescribers may submit written requests via the Special Authority fax line at any time. A coverage decision should be provided within one business day.
- Urgent Special Authority requests can be made:
- if the patient meets any of the criteria. The prescriber can contact the Special Authority line Monday to Friday, 8:00 a.m. to 4:00 p.m. (excluding statutory holidays), to request authorization; or
- after hours, if a patient meets any of the criteria, a prescriber can contact the PharmaNet Help Desk (available 24 hours per day, 7 days per week) to request initial urgent Special Authority for vancomycin. All requests for renewal of existing coverage must be made through Special Authority via fax or phone during regular business hours.
- pharmacists may request Special Authority coverage for vancomycin being dispensed following a hospital stay. For more information regarding when pharmacists can request Special Authority, please see: Limited Coverage Drugs: information for pharmacies.