Limited Use Note(s) |
|
FAMCICLOVIR500mg Tab
| Reason For Use Code | Clinical Criteria |
|---|---|
| 147 | Herpes zoster in patients 50 years of age or older, up to 72 hours* after appearance of lesions. Dose: 500mg 3 times/day for 7 days. |
| *The patient must begin treatment within the time frame specified for the product to be reimbursed. There is no benefit from the therapy begun after this time frame. | |
| NETWORK NOTE: Network will limit supply to 7 days and 21 tablets. | |
| LU Authorization Period: 1 year |