UnitedHealthcare
Xifaxan (rifaximin)
Drugs for Infections : Antibiotics
  • Step Therapy: Gastro: IBS-D:
    ST Single Generic

  • Prior Authorization: Gastro: IBS-D:
    Duration: 14 Day(s)

  • Gastro: IBS-D:
    Duration: 14 Day(s)
    Medical Test Required: No
    Reauthorization Required: No
    REMs Program Criteria Included: No
    Policy States Patient Must Have a Documented Trial and Failure of Diet, Exercise and Counseling: No
    Documented Diagnosis: No
    Chronic IBS Symptoms for 6 Months or Longer: No
    Non-pharmacologic Therapy: No
    Patient Must Have Documented Symptoms of Loose Watery Stools: No

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