Daraprim — CareFirst (Caremark)

Initial criteria

• The requested drug is being prescribed for Pneumocystis jirovecii pneumonia prophylaxis OR primary prophylaxis of toxoplasmosis.
• The patient has experienced an intolerance or has a contraindication to sulfamethoxazole/trimethoprim.
• The patient has had a CD4 cell count less than 200 cells/mm3 within the past 3 months.

Approval duration

3 months