Posfrea — CareFirst (Caremark)

Initial criteria

• For Hyperemesis Gravidarum: ALL of the following must be met: patient is pregnant AND patient has a documented risk for hospitalization AND request is for ondansetron AND patient has experienced an inadequate treatment response, intolerance, or a contraindication to TWO of the following: dimenhydrinate (Dramamine), diphenhydramine (Benadryl), doxylamine/pyridoxine delayed-release (Diclegis), doxylamine/pyridoxine extended-release (Bonjesta), metoclopramide (Reglan), promethazine (Phenergan), trimethobenzamide (Tigan), vitamin B6, or vitamin B6 with doxylamine.
• For radiation therapy or moderate to highly emetogenic chemotherapy: authorization may be granted when the patient is receiving radiation therapy or moderate to highly emetogenic chemotherapy.

Approval duration

6 months