Health Net
Baxdela (delafloxacin)
Drugs for Infections : Antibiotics
  • Prior Authorization: ABSSSI:
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 14 Day(s)
    Reauthorization Required: Yes

    Community Acquired Bacterial Pneumonia:
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 10 Day(s)
    Reauthorization Required: Yes

  • Step Therapy: ABSSSI:
    ST Single Generic

  • ABSSSI:
    Age Requirement: >= 18
    Duration: 14 Day(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 14 day(s)

    Community Acquired Bacterial Pneumonia:
    Age Requirement: >= 18
    Duration: 10 Day(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: <= 10 day(s)

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