Tamiflu (oseltamivir) — CareFirst (Caremark)

Initial criteria

• Authorization may be granted when ONE of the following criteria are met:
• The requested drug is being prescribed for treatment of acute uncomplicated influenza in a patient age ≥ 5 years who is otherwise healthy or at high risk of developing influenza-related complications AND the request is for Xofluza (baloxavir marboxil).
• The requested drug is being prescribed for post-exposure prophylaxis of influenza in a patient age ≥ 5 years following contact with an individual who has influenza AND the request is for Xofluza (baloxavir marboxil).
• The requested drug is being prescribed for the prophylaxis of influenza A or B viral infection in a patient age ≥ 3 months during a community outbreak AND the request is for Tamiflu (oseltamivir).
• The requested drug is being prescribed for the prophylaxis of influenza A or B viral infection in a patient age ≥ 5 years during a community outbreak AND the request is for Relenza (zanamivir).
• The requested drug (Tamiflu or Relenza) is being prescribed for the prophylaxis (prevention) OR the treatment of influenza A or B viral infection.

Approval duration

3 months