Voriconazole (oral) — Medica
Fungal infection (systemic) that is susceptible to voriconazole – treatment
Preferred products
- generic voriconazole (tablet or oral suspension)
Initial criteria
- Approve for 3 months if the patient meets ONE of the following (A or B):
- A) Generic voriconazole tablets or oral suspension is requested; OR
- B) Patient meets BOTH of the following (i and ii):
- i. Patient has tried the corresponding generic voriconazole product (tablet or oral suspension); AND
- ii. Patient cannot take the generic voriconazole product due to a formulation difference in the inactive ingredient(s) (e.g., difference in dyes, fillers, preservatives) between the brand and the bioequivalent generic product, which per the prescriber, would result in a significant allergy or serious adverse reaction.
Reauthorization criteria
- Patient is currently receiving voriconazole. Approve for 3 months to complete the course of therapy if the patient meets ONE of the following (A or B):
- A) Generic voriconazole tablets or oral suspension is requested; OR
- B) Patient meets BOTH of the following (i and ii):
- i. Patient has tried the corresponding generic voriconazole product (tablet or oral suspension); AND
- ii. Patient cannot take the generic voriconazole product due to a formulation difference in the inactive ingredient(s) (e.g., difference in dyes, fillers, preservatives) between the brand and the bioequivalent generic product, which per the prescriber, would result in a significant allergy or serious adverse reaction.
Approval duration
3 months