Talicia (omeprazole, amoxicillin, and rifabutin) — Highmark

Initial criteria

• age ≥ 18 years
• Diagnosis of H. pylori infection (ICD-10: B96.81) confirmed by either invasive techniques (e.g., endoscopic) OR non-invasive techniques (e.g., urea breath test, stool antigen assay test)
• Previously treated with all of the following components of a first-line treatment regimen AND post-treatment testing has confirmed the treatments have failed to eradicate the H. pylori infection: 1. PPI 2. bismuth subcitrate OR bismuth subsalicylate 3. tetracycline 4. metronidazole

Approval duration

14 days