albendazole — CareFirst (Caremark)

Initial criteria

• The infection has been confirmed by a diagnostic or laboratory test (e.g., imaging scans, scotch tape test, blood, stool, or urine test).
• Request for Emverm (mebendazole) is in a patient age ≥ 2 years for a second course of therapy (first course of therapy administered within the past year) at a dose up to 2 tablets per day for two 3‑day treatments for Ancylostoma duodenale, Ascaris lumbricoides, Enterobius vermicularis, Necator americanus, or Trichuris trichiura.
• Request for albendazole is for treatment of hydatid disease for a second course of therapy (first course administered within the past year) at a dose up to 4 tablets per day for three 28‑day cycles with 14‑day free intervals.
• Request for Biltricide (praziquantel) is in a patient age ≥ 1 year for the treatment of schistosomiasis, clonorchiasis, or opisthorchiasis for any of the following: quantity up to 36 tablets, a second day or course of therapy (first course administered within the past year).
• Request for Egaten (triclabendazole) is in a patient age ≥ 6 years for the treatment of fascioliasis for any of the following: quantity up to 32 tablets, a second day or course of therapy (first course administered within the past year).

Approval duration

albendazole: 4 months; Biltricide: 1 month; Egaten: 1 month; Emverm: 1 month