Emverm — CareFirst (Caremark)

Initial criteria

• Infection confirmed by diagnostic or laboratory test (e.g., imaging scan, scotch tape test, blood, stool, or urine test)
• Request for mebendazole (Emverm) in a patient age ≥ 2 years for a second course of therapy (first course 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 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 praziquantel (Biltricide) in a patient age ≥ 1 year for schistosomiasis, clonorchiasis, or opisthorchiasis for up to 36 tablets or a second course within the past year
• Request for triclabendazole (Egaten) in a patient age ≥ 6 years for fascioliasis for up to 32 tablets or a second course within the past year

Approval duration

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