triclabendazole — CareFirst (Caremark)

Initial criteria

• The infection has been confirmed by a diagnostic or laboratory test (e.g., imaging scans, scotch tape test, blood, stool, or urine test)
• Request is for triclabendazole (Egaten) in a patient age ≥ 6 years for the treatment of fascioliasis for ANY of the following: quantity up to 32 tablets, a second day or course of therapy (first course of therapy administered within the past year)

Approval duration

1 month