praziquantel — CareFirst (Caremark)
Schistosomiasis due to all species of Schistosoma
Initial criteria
- Infection confirmed by a diagnostic or laboratory test (e.g., imaging scans, scotch tape test, blood, stool, or urine test)
- Patient age ≥ 1 year
- Request is for praziquantel (Biltricide) for treatment of schistosomiasis, clonorchiasis, or opisthorchiasis for ANY of the following: a quantity up to 36 tablets, a second day or course of therapy (first course of therapy administered within the past year)
Approval duration
1 month