Sporanox — CareFirst (Caremark)
Cryptococcosis
Preferred products
- fluconazole
- griseofulvin
- terbinafine
Initial criteria
- The requested drug is NOT being used in a footbath
- The requested drug is being prescribed for ANY listed indication
- For Tinea corporis, Tinea cruris, Tinea capitis, Tinea manuum, or Tinea pedis the patient experienced an inadequate treatment response, intolerance, or has a contraindication to ANY of the following: fluconazole, griseofulvin, terbinafine
- For onychomycosis, diagnosis confirmed by a fungal diagnostic test (e.g., KOH preparation, fungal culture, or nail biopsy)
Approval duration
Pityriasis versicolor, Tinea versicolor, Onychomycosis due to dermatophytes (Tinea unguium), Tinea corporis, Tinea cruris, Tinea capitis, Tinea manuum, Tinea pedis: 3 months; Blastomycosis, Primary therapy for allergic bronchopulmonary aspergillosis, Aspergillosis, Coccidioidomycosis, Cryptococcosis, Sporotrichosis, Talaromycosis (formerly Penicilliosis), Microsporidiosis, Invasive fungal infection prophylaxis in a liver transplant patient, Invasive fungal infection prophylaxis in a patient with a hematologic malignancy: 6 months; Histoplasmosis, Histoplasmosis prophylaxis in HIV infection, Coccidioidomycosis prophylaxis in HIV infection, Invasive fungal infection prophylaxis in a patient with chronic granulomatous disease, Primary therapy for chronic cavitary pulmonary aspergillosis: 12 months