Jublia (efinaconazole) — United Healthcare
onychomycosis of the toenail due to Trichophyton rubrum or Trichophyton mentagrophytes
Preferred products
- itraconazole (generic Sporanox)
- oral terbinafine (generic Lamisil)
- ciclopirox (generic Penlac)
Initial criteria
- Submission of medical records (laboratory and clinical documentation) confirming diagnosis of onychomycosis of the toenail with Trichophyton rubrum OR Trichophyton mentagrophytes (if request is for a subsequent course of therapy a new test must be performed)
- Treatment is requested due to medical condition and not for cosmetic purposes (e.g., patients with history of cellulitis of the lower extremity who have ipsilateral toenail onychomycosis, patients with diabetes who have additional risk factors for cellulitis, patients who experience pain/discomfort associated with the infected nail)
- History of failure after a minimum of 12 weeks of treatment, contraindication, or intolerance to TWO of the following antifungal agents (document date of trial): itraconazole (generic Sporanox), oral terbinafine (generic Lamisil), ciclopirox (generic Penlac)
Approval duration
48 weeks