itraconazole oral solution — CareFirst (Caremark)
Esophageal candidiasis
Preferred products
- fluconazole
Initial criteria
- Authorization may be granted when the requested drug is being prescribed for the treatment of esophageal candidiasis or oropharyngeal candidiasis when ONE of the following criteria are met:
- The patient has experienced an inadequate treatment response to fluconazole
- The patient has experienced an intolerance to fluconazole
- The patient has a contraindication that would prohibit a trial of fluconazole
Approval duration
6 months