Vowst — Blue Cross Blue Shield of Alabama

Initial criteria

• - The requested agent will be used to prevent the recurrence of Clostridioides difficile infection (CDI)
• - The patient has a diagnosis of recurrent CDI as defined by ALL of the following:
• • ≥ 3 episodes of CDI in a 12-month period
• • Positive C. difficile stool sample
• • CDI episode of diarrhea ≥ 3 unformed stools per day for at least 2 consecutive days
• - The patient has completed a standard-of-care oral antibiotic regimen (e.g., vancomycin, fidaxomicin) for recurrent CDI at least 2 to 4 days before initiating treatment with the requested agent
• - The patient has had an adequate clinical response to a standard-of-care oral antibiotic regimen (e.g., vancomycin, fidaxomicin) as defined by < 3 unformed stools in 24 hours for ≥ 2 consecutive days
• - The patient will NOT be using the requested agent in combination with any antibiotic regimen for any indication
• - If the patient has an FDA-approved indication, then ONE of the following (unspecified options follow in next segment)