Get the free FIDAXOMICIN (Dificid™) PRIOR REVIEW/CERTIFICATION FAXBACK FORM

This document is used by healthcare providers to request prior review and certification for the prescription of FIDAXOMICIN (Dificid™) for patients, requiring specific patient and prescriber information

How to fill out fidaxomicin dificid prior reviewcertification

How to fill out FIDAXOMICIN (Dificid™) PRIOR REVIEW/CERTIFICATION FAXBACK FORM

1. Begin by downloading the FIDAXOMICIN (Dificid™) PRIOR REVIEW/CERTIFICATION FAXBACK FORM from the appropriate healthcare portal.
2. Fill in the patient's personal information at the top of the form, including name, ID number, and date of birth.
3. Provide the prescribing physician's details, including name, contact number, and medical license number.
4. Indicate the dosage and quantity of FIDAXOMICIN being requested.
5. Include relevant diagnosis information and any supporting medical documentation to justify the need for FIDAXOMICIN.
6. Verify that all sections of the form are completed accurately to prevent delays in review.
7. Sign and date the form where indicated.
8. Fax the completed form to the designated review entity's fax number as provided in the instructions.

Who needs FIDAXOMICIN (Dificid™) PRIOR REVIEW/CERTIFICATION FAXBACK FORM?

1. Patients who are prescribed FIDAXOMICIN (Dificid™) for the treatment of Clostridium difficile infections.
2. Healthcare providers seeking prior authorization or certification for insurance coverage of FIDAXOMICIN.
3. Pharmacies that need to confirm coverage before dispensing FIDAXOMICIN.

People Also Ask about

What class of drug is fidaxomicin?

Fidaxomicin belongs to the class of medicines known as macrolide antibiotics. It works by killing bacteria or preventing their growth. However, this medicine will not work for colds, flu, or other virus infections. This medicine is available only with your doctor's prescription.

Is the same as fidaxomicin?

CONCLUSION. Fidaxomicin () is a macrolide antibacterial agent indicated for adults with CDAD. Fidaxomicin was approved on the basis of two randomized, double-blind, non-inferiority studies in which the clinical response to twice-daily fidaxomicin was similar to the response to four-times-daily vancomycin.

How quickly does fidaxomicin work?

In studies of adults who took (fidaxomicin), it took about 3 days for diarrhea to go away after starting (fidaxomicin). Speak to your prescriber if you're concerned with how quickly (fidaxomicin) is working for you.

What is the generic name for fidaxomicin?

(fidaxomicin) is a macrolide antibacterial drug used to reduce the development of drug-resistant bacteria and to treat Clostridium difficile-associated diarrhea (CDAD) in adults over the age of 18.

What is the FDA approved treatment for C. diff?

The U.S. Food and Drug Administration (FDA) has approved VOWST™, a microbiota-based therapeutic to prevent recurrence of C. difficile Infection (CDI) in adults following antibacterial treatment for recurrent CDI (rCDI).

Is fidaxomicin FDA approved?

Fidaxomicin is an oral narrow-spectrum novel 18-membered macrocyclic antibiotic that was initially approved in 2011 by the US FDA for the treatment of Clostridioides difficile infections (CDI) in adults. In February 2020, the FDA approved fidaxomicin for the treatment of CDI in children age >6 months.

When was fidaxomicin FDA approved?

On April 5, 2011, the drug won an FDA advisory panel's unanimous approval for the treatment of Clostridioides difficile infection, and gained full FDA approval on May 27, 2011. As of January 2020, fidaxomicin is FDA-approved for use in children aged 6 months and older for C. difficile associated diarrhea (CDAD).

Is fidaxomicin safe?

Fidaxomicin is poorly absorbed; therefore, serious adverse effects are rare. There are no known drug-drug interactions or contraindications with use. Fidaxomicin should not be used for systemic infections, and should be used only for infections proven or strongly suspected to be caused by C. difficile.

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What is FIDAXOMICIN (Dificid™) PRIOR REVIEW/CERTIFICATION FAXBACK FORM?

FIDAXOMICIN (Dificid™) PRIOR REVIEW/CERTIFICATION FAXBACK FORM is a document used to request prior authorization for the medication FIDAXOMICIN, ensuring that it is clinically necessary for the patient as determined by the prescribing physician.

Who is required to file FIDAXOMICIN (Dificid™) PRIOR REVIEW/CERTIFICATION FAXBACK FORM?

Healthcare providers or prescribers who intend to dispense FIDAXOMICIN (Dificid™) for patients typically need to file the PRIOR REVIEW/CERTIFICATION FAXBACK FORM.

How to fill out FIDAXOMICIN (Dificid™) PRIOR REVIEW/CERTIFICATION FAXBACK FORM?

To fill out the FIDAXOMICIN (Dificid™) PRIOR REVIEW/CERTIFICATION FAXBACK FORM, the healthcare provider must complete patient information, indicate the medical necessity, provide any required clinical history, and include prescribing physician details before submitting it to the appropriate payer.

What is the purpose of FIDAXOMICIN (Dificid™) PRIOR REVIEW/CERTIFICATION FAXBACK FORM?

The purpose of the FIDAXOMICIN (Dificid™) PRIOR REVIEW/CERTIFICATION FAXBACK FORM is to evaluate the necessity of the medication and ensure that the patient's treatment aligns with coverage criteria set by insurers.

What information must be reported on FIDAXOMICIN (Dificid™) PRIOR REVIEW/CERTIFICATION FAXBACK FORM?

The information that must be reported on the FIDAXOMICIN (Dificid™) PRIOR REVIEW/CERTIFICATION FAXBACK FORM includes patient demographic details, medication dosage, duration of treatment, clinical rationale for use, and supporting medical history.