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Zegerid — CareFirst (Caremark)

Duodenal ulcer

Preferred products

  • generic proton pump inhibitors

Initial criteria

  • The patient has experienced an inadequate treatment response, intolerance, or a contraindication to THREE generic proton pump inhibitors.
  • For Zegerid (omeprazole/sodium bicarbonate): The prescription is for treatment of gastroesophageal reflux disease (GERD), duodenal ulcer, gastric ulcer, short-term treatment of erosive esophagitis, or maintenance of healing of erosive esophagitis.
  • For Konvomep (omeprazole/sodium bicarbonate): The prescription is for short-term treatment of gastric ulcer.

Approval duration

3 months (Konvomep and Zegerid for GERD, duodenal ulcer, gastric ulcer, short-term treatment of erosive esophagitis); 12 months (Zegerid for maintenance healing of erosive esophagitis)