promethazine and codeine oral solution — CareFirst (Caremark)

Initial criteria

• Authorization may be granted when the requested drug is being prescribed for persistent cough requiring treatment beyond 7 days when ALL of the following criteria are met:
• The patient has been reevaluated for the cause of the cough to address any underlying pathology, such as foreign body or lower respiratory tract disease.
• The need for continued use of the requested drug has been assessed considering the relative incidence of adverse reactions, and the development of addiction, abuse, or misuse.

Approval duration

1 month