Virazole (ribavirin inhalation solution - Bausch, generic) — Cigna

Initial criteria

• Patient is hospitalized; AND
• Patient meets ONE of the following (i, ii, or iii): i. Patient is a solid organ transplant recipient; OR ii. Patient has had a hematopoietic stem cell transplant; OR iii. Patient has cancer; AND
• The medication is prescribed by or in consultation with a critical care specialist, transplant physician, oncologist, infectious diseases physician, or pulmonologist.

Approval duration

1 month