Noxafil (posaconazole) delayed-release tablets — Highmark
Prophylaxis of invasive Aspergillus and Candida infections in severely immunocompromised patients
Preferred products
- generic posaconazole delayed-release tablets
- generic posaconazole oral suspension
Initial criteria
- Request is for Noxafil (posaconazole) delayed-release tablets, oral suspension, or PowderMix for delayed-release oral suspension
- Member meets one of the following:
- a. For delayed-release tablets: member is age ≥ 2 years AND weight > 40 kg AND if brand Noxafil requested, therapeutic failure or intolerance to generic posaconazole delayed-release tablets
- b. For oral suspension: member is age ≥ 13 years AND unable to swallow tablets AND if brand Noxafil requested, therapeutic failure or intolerance to generic posaconazole oral suspension
- c. For PowderMix formulation: member is age ≥ 2 years AND weight ≤ 40 kg AND if age ≥ 13 years, therapeutic failure or intolerance to plan-preferred generic posaconazole oral suspension
- Member is at high risk of developing invasive Aspergillosis or Candidiasis infection due to being severely immunocompromised (e.g., HSCT recipients with GVHD, hematologic malignancy with prolonged neutropenia from chemotherapy)
Reauthorization criteria
- Prescriber attests that the member has experienced positive clinical response to therapy
Approval duration
12 months