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VIBERZI and XIFAXAN PHARMACY COVERAGE GUIDELINES ORIGINAL EFFECTIVE DATE: 1/19/2017 SECTION: DRUGS LAST REVIEW DATE: 5/20/2021 LAST CRITERIA REVISION DATE: 5/20/2021 ARCHIVE DATE: VIBERZI™ (eluxadoline) XIFAXAN® (rifaximin) Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Pharmacy Coverage Guideline must be read in its entirety to determine coverage eligibility, if any. This Pharmacy Coverage Guideline provides information related to coverage determinations only and does not imply that a service or treatment is clinically appropriate or inappropriate. The provider and the member are responsible for all decisions regarding the appropriateness of care. Providers should provide BCBSAZ complete medical rationale when requesting any exceptions to these guidelines. The section identified as “Description” defines or describes a service, procedure, medical device or drug and is in no way intended as a statement of medical necessity and/or coverage. The section identified as “Criteria” defines criteria to determine whether a service, procedure, medical device or drug is considered medically necessary or experimental or investigational. State or federal mandates, e.g., FEP program, may dictate that any drug, device or biological product approved by the U.S. Food and Drug Administration (FDA) may not be considered experimental or investigational and thus the drug, device or biological product may be assessed only on the basis of medical necessity. Pharmacy Coverage Guidelines are subject to change as new information becomes available. For purposes of this Pharmacy Coverage Guideline, the terms "experimental" and "investigational" are considered to be interchangeable. BLUE CROSS®, BLUE SHIELD® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. All other trademarks and service marks contained in this guideline are the property of their respective owners, which are not affiliated with BCBSAZ. This Pharmacy Coverage Guideline does not apply to FEP or other states’ Blues Plans. Information about medications that require precertification is available at www.azblue.com/pharmacy. Some large (100+) benefit plan groups may customize certain benefits, including adding or deleting precertification requirements. All applicable benefit plan provisions apply, e.g., waiting periods, limitations, exclusions, waivers and benefit maximums. Precertification for medication(s) or product(s) indicated in this guideline requires completion of the request form in its entirety with the chart notes as documentation. All requested data must be provided. Once completed the form must be signed by the prescribing provider and faxed back to BCBSAZ Pharmacy Management at (602) 864-3126 or emailed to [email protected]. Incomplete forms or forms without the chart notes will be returned. Page 1 of 13 PHARMACY COVERAGE GUIDELINES ORIGINAL EFFECTIVE DATE: 1/19/2017 SECTION: DRUGS LAST REVIEW DATE: 5/20/2021 LAST CRITERIA REVISION DATE: 5/20/2021 ARCHIVE DATE: VIBERZI™ (eluxadoline) XIFAXAN® (rifaximin) Section A. Irritable Bowel Syndrome with Diarrhea: Viberzi (eluxadoline) Xifaxan (rifaximin) Criteria: Criteria for initial therapy: Viberzi (eluxadoline) or Xifaxan (rifaximin) is considered medically necessary and will be approved when ALL of the following criteria are met: 1. Prescriber is a physician specializing in the patient’s diagnosis or is in consultation with a Gastroenterologist 2. Individual is 18 years of age or older 3. A confirmed diagnosis of moderate to severe Irritable Bowel Syndrome with Diarrhea (IBS-D) with symptoms of moderate abdominal pain, discomfort and bloating 4. The recurrent symptoms are present, on average, at least 1 day per week during the preceding 3 months associated with 2 or more of the following: related to defecation, associated with a change in stool frequency, associated with a change in stool form/appearance 5. The abnormal diarrheal bowel movements are Bristol Stool Form Scale (BSFS) type 6 or 7 6. Failed dietary modification that includes lactose restricted diet, if lactose-intolerant; exclusion of gas- producing foods; low carbohydrate diet and elimination of fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) 7. Documented failure, contraindication per FDA label, or intolerance is ONE of the following: a. For Viberzi: i. Dicyclomine OR hyoscyamine AND ii. Amitriptyline OR nortriptyline b. For Xifaxan: i. Dicyclomine AND hyoscyamine AND ii. amitriptyline OR nortriptyline AND iii. Viberzi 8. Will not be used for diarrhea complicated by fever or blood in stool 9. There are NO FDA-label contraindications, such as: a. FDA-label contraindications for Viberzi (eluxadoline) include: i. Individual without a gallbladder Page 2 of 13 PHARMACY COVERAGE GUIDELINES ORIGINAL EFFECTIVE DATE: 1/19/2017 SECTION: DRUGS LAST REVIEW DATE: 5/20/2021 LAST CRITERIA REVISION DATE: 5/20/2021 ARCHIVE DATE: VIBERZI™ (eluxadoline) XIFAXAN® (rifaximin) ii. Known or suspected biliary duct obstruction or sphincter of Oddi disease or dysfunction iii. Alcoholism, alcohol abuse or alcohol addiction, or in patients who drink > 3 alcoholic beverages per day iv. A history of pancreatitis; structural diseases of the pancreas, including known or suspected pancreatic duct obstruction v. Severe hepatic impairment (Child-Pugh Class C) vi. A history of chronic or severe constipation or sequelae from constipation, or known or suspected mechanical gastrointestinal obstruction b. FDA-label contraindications for Xifaxan include: i. History of hypersensitivity to rifaximin, rifamycin antimicrobial agents, or any of the components of Xifaxan Initial approval duration: Viberzi: 6 months Xifaxan: 550 mg three times a day for 14-day course with two refills No other dose, frequency, or duration will be approved Criteria for continuation of coverage (renewal request): Viberzi (eluxadoline) only is considered medically necessary and will be approved when ALL of the following criteria are met: 1. Individual continues to be seen by a physician specializing in the patient’s diagnosis or is in consultation with a Gastroenterologist 2. Individual’s condition has responded while on therapy a. Response is defined as both: i. Achieved and maintains BSFS type of 3 or 4 on at least 3 or 4 days ii. At least a 50% reduced symptoms of abdominal pain, discomfort, and bloating 3. Individual has been adherent with the medication 4. Individual has not developed any contraindications or other significant adverse drug effects that may exclude continued use a. Contraindications as listed in the criteria for initial therapy section b. Significant adverse effect such as: i. Liver toxicity ii. Pancreatitis iii. Sphincter of Oddi spasm iv. Constipation v. Hypersensitivity 5. There are no significant interacting drugs Renewal duration: 12 months Page 3 of 13 PHARMACY COVERAGE GUIDELINES ORIGINAL EFFECTIVE DATE: 1/19/2017 SECTION: DRUGS LAST REVIEW DATE: 5/20/2021 LAST CRITERIA REVISION DATE: 5/20/2021 ARCHIVE DATE: VIBERZI™ (eluxadoline) XIFAXAN® (rifaximin) Criteria for a request for non-FDA use or indication, treatment with dosing, frequency, or duration outside the FDA-approved dosing, frequency, and duration, refer to one of the following Pharmacy Coverage Guideline: 1. Off-Label Use of a Non-Cancer Medications 2. Off-Label Use of a Cancer Medication for the Treatment of Cancer without a Specific Coverage Guideline Section B. Travelers’ Diarrhea: Xifaxanan (rifaximin) Criteria: Criteria for therapy: Xifaxan (rifaximin) is considered medically necessary and will be approved when ALL of the following criteria are met: 1. Individual is 12 years of age or older 2. A confirmed diagnosis of Travelers’ diarrhea caused by noninvasive strains of Escherichia coli 3. Documented failure, contraindication per FDA label, or intolerance to EITHER azithromycin OR ciprofloxacin OR levofloxacin 4. There are NO FDA label contraindications, such as: a. History of hypersensitivity to rifaximin, rifamycin antimicrobial agents, or any of the components of Xifaxan 5. Will not be used for diarrhea complicated by fever or blood in stool 6. Will not be used for diarrhea caused by bacteria other than Escherichia coli 7. Will not be used for diarrhea associated with use of antibiotics Approval duration: 200 mg three times a day for 3 days, one-time approval, no refills No other dose, frequency, or duration will be approved Criteria for a request for non-FDA use or indication, treatment with dosing, frequency, or duration outside the FDA-approved dosing, frequency, and duration, refer to one of the following Pharmacy Coverage Guideline: 1. Off-Label Use of a Non-Cancer Medications 2. Off-Label Use of a Cancer Medication for the Treatment of Cancer without a Specific Coverage Guideline Page 4 of 13 PHARMACY COVERAGE GUIDELINES ORIGINAL EFFECTIVE DATE: 1/19/2017 SECTION: DRUGS LAST REVIEW DATE: 5/20/2021 LAST CRITERIA REVISION DATE: 5/20/2021 ARCHIVE DATE: VIBERZI™ (eluxadoline) XIFAXAN® (rifaximin) Section C. Hepatic Encephalopathy: Xifaxan (rifaximin) Criteria: Criteria for initial therapy: Xifaxan (rifaximin) is considered medically necessary and will be approved when ALL of the following criteria are met: 1. Prescriber is a physician specializing in the patient’s diagnosis or is in consultation with a Gastroenterologist or Hepatologist 2. Individual is 18 years of age or older 3. A confirmed
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