Impavido (miltefosine capsules - Profounda) — Cigna
Ameba-related infections (Acanthamoeba, Balamuthia mandrillaris, Naegleria fowleri)
Initial criteria
- Patient is being treated for an infection due to ONE of the following: Acanthamoeba OR Balamuthia mandrillaris OR Naegleria fowleri
- Medication is prescribed by or in consultation with an infectious diseases specialist
Approval duration
1 month