Xofluza™

Drug - Xofluza™ (baloxavir) [Genentech, Inc.]

June 2019

Therapeutic Area - Antivirals

Approval criteria

• Patient must be 12 years of age or older AND
• Patient must be at least 40 kg AND
• Patient must have acute, uncomplicated influenza AND
• Patient has been symptomatic for no more than 48 hours AND
• Patient is:
  • NOT on concurrent neuraminidase inhibitors (e.g., Tamiflu, Relenza) AND
  • NOT pregnant AND
  • NOT hospitalized AND
• Xofluza is NOT prescribed for influenza prophylaxis AND
• If patient is 12 years of age or older, prescriber must provide a reason oseltamivir is not clinically appropriate for the patient (i.e., the convenience of the patient, prescriber, or other health care provider will not be considered)

Quantity limits

• 40 mg dose: one 2 x 20 mg blister card OR
• 80 mg dose: one 2 x 40 mg blister card AND 
• Patient’s body weight (in kg) must be provided at time of request

Questions?

MHCP Provider Call Center 651-431-2700 or 800-366-5411