Vowst — Blue Cross Blue Shield of Oklahoma

Initial criteria

• The requested agent will be used to prevent recurrence of CDI
• Patient has a diagnosis of recurrent CDI defined by all of the following: ≥3 episodes of CDI in a 12‑month period; a positive C. difficile stool sample; an episode of ≥3 unformed stools per day for ≥2 consecutive days
• Patient has completed a standard of care oral antibiotic regimen (e.g., vancomycin, fidaxomicin) for recurrent CDI at least 2–4 days before starting the requested agent
• Patient has shown adequate clinical response to a standard of care oral antibiotic regimen, defined as <3 unformed stools in 24 hours for ≥2 consecutive days
• Requested agent will not be used in combination with any antibiotic regimen for any indication
• Patient age is within FDA labeling for the requested indication OR there is support for use at the patient’s age for the requested indication
• Prescriber is a specialist in the area of the patient’s diagnosis (e.g., infectious disease, gastroenterology) or has consulted such a specialist
• Patient has no FDA‑labeled contraindications to the requested agent

Approval duration

1 course per 12 months