alosetron — United Healthcare
severe diarrhea-predominant irritable bowel syndrome (IBS)
Initial criteria
- Diagnosis of severe diarrhea-predominant irritable bowel syndrome (IBS) with symptoms for at least six months
- AND Patient was female at birth
- AND Has not responded adequately to conventional therapy (e.g., loperamide, antispasmodics)
- AND Anatomic or biochemical abnormalities of the GI tract have been excluded
Reauthorization criteria
- Documentation of positive clinical response to Lotronex therapy
Approval duration
12 months