Teva-Voriconazole

Outpatient continuation of treatment for documented invasive aspergillosis in patients who have demonstrated a clinical response to either oral or parenteral voriconazole.

*The first prescription must be written by a physician based at the hospital where the patient was hospitalized.

Note: Limited to 3 months of reimbursement.

Voriconazole

• Brand(s): VFend
• Dosage Form/Strength: 50 mg, 200 mg tablets, 200 mg/vial injection

For the treatment of patients who have culture positive candidemia, due to Candida species, AND with documented resistance to fluconazole.

This will be for patients whose therapy is initiated in the hospital by a hospital physician and who require continuation of therapy when they are discharged as an outpatient. Oral tablets will be authorized for those with a properly functioning gastrointestinal (GI) tract and the parental injection will be authorized for those who do not have a properly functioning GI.

Case-by-case consideration for other indications will be provided.

Duration of Approval: 1 month

EAP Drug Request Form:

Standard Form for EAP Drug Requests