Vancocin (vancomycin capsules – Ani Pharmaceuticals, generic) — Cigna

Initial criteria

• The medication is being prescribed for a Food and Drug Administration (FDA)-approved indication OR other use with supportive evidence
• The medication is not being used in conjunction with one or more of the following topical products: clindamycin, clotrimazole, ketoconazole, or mupirocin

Approval duration

2 weeks