Mytesi (crofelemer) — Point32Health
Symptomatic relief of non-infectious diarrhea in adult patients with HIV/AIDS on anti-retroviral therapy
Preferred products
- Anti-retroviral therapy (as listed on formulary)
Initial criteria
- Medication requested is for the symptomatic relief of non-infectious diarrhea in an adult patient who is currently on anti-retroviral therapy
- The patient has had a trial of one (1) Step-1 or Step-2 medication within the previous 180 days as evidenced by a previous paid claim under the prescription benefit administered by the plan