Xifaxan — United Healthcare
Travelers’ Diarrhea
Preferred products
- azithromycin
- ciprofloxacin
- levofloxacin
- ofloxacin
Initial criteria
- Diagnosis of travelers’ diarrhea
- History of failure, contraindication or intolerance to one of the following: azithromycin (generic Zithromax) OR ciprofloxacin (generic Cipro) OR levofloxacin (generic Levaquin) OR ofloxacin (generic Floxin)
Approval duration
1 month