Pretomanid tablets (Mylan) — Cigna
Tuberculosis
Initial criteria
- Patient age ≥ 18 years
- Patient meets ONE of the following: (i) extensively drug resistant tuberculosis; OR (ii) treatment-intolerant tuberculosis; OR (iii) nonresponsive multidrug-resistant tuberculosis
- Pretomanid is prescribed in combination with Sirturo (bedaquiline tablets) and linezolid tablets or oral suspension (Zyvox, generic)
- Medication is prescribed by or in consultation with an infectious diseases specialist
Approval duration
9 months