Rational Drug Therapy Program  WVBMS Drug Therapy Guidelines  Neuramindase Inhibitor Criteria (Oral Influenza Treatment Agents)   Neuramindase Inhibitor Criteria Form

WV Bureau for Medical Services Criteria for Prior Approval of Neuraminidase Inhibitors:                  

Prescriptions for neuraminidase inhibitors require prior authorization.  However, amantadine and ramantadine will not require prior authorization.  Should epidemic influenza B be found in the larger communities in West Virginia, as reported by the Bureau for Public Health, prior authorization would not longer be required.  The following prior approval criteria have been established:

1.     Coverage is limited to treatment of influenza, not prevention.

2.     Patient must have documented influenza type B, or there must be a documented influenza type B outbreak in the patient’s community.

3.     Patient must not be symptomatic for greater than 48 hours.

Prior Approval Request Information Needed:

Date of patient’s onset of symptoms:                                      _________________________

Does this patient have Influenza Type B?                                __________________________

What test was used to differentiate between 

Influenza Type A and Influenza Type B?             __________________________

Influenza Online Monitoring Sources:

United States:  Influenza Outbreak Monitoring - Center for Disease Control (CDC)

http://www.cdc.gov/ncidod/diseases/flu/weeklyarchives/previousreports.htm

 West Virginia: Infectious Disease Epidemiology Program - Influenza Surveillance

http://www.wvdhhr.org/bph/oehp/sdc/Flu_Surv.htm

Click here to go to Neuraminidase Justification

Rational Drug Therapy Program  West Virginia University School of Pharmacy  P.O. Box 9511  Morgantown, WV 26506-9511  Phone 800 847 3859  Fax 800 531 7787