Fulyzaq

Drug - Fulyzaq™ [Salix]

October 2013

Therapeutic area - Antidiarrheal

Approval criteria

• Patient is 18 years of age or older AND
• Patient has a diagnosis of HIV/AIDS AND
• Patient has a history of antiretroviral therapy AND
• Patient has a diagnosis of non-infectious diarrhea AND
• Patient has a history of 3 prior trials of antidiarrheal therapy (bismuth subsalicylate, diphenoxylate, loperamide)

Quantity limit

Dose is one tablet orally twice daily; quantity limit is 68 tablets per 34-day supply.

Background information

Fulyzaq™(crofelemer) is an anti-diarrheal indicated for the relief of non-infectious diarrhea in adult patients with HIV/AIDS on anti-retroviral therapy. 

Questions?

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