Limited Use Note(s) |
|
VALGANCICLOVIR450mg Tab
| Reason For Use Code | Clinical Criteria |
|---|---|
| 374 | For the treatment of CMV retinitis in patients with HIV/AIDS. |
| LU Authorization Period: 1 year | |
| 568 | For the prevention of Cytomegalovirus (CMV) in solid organ transplant patients (not lung or heart-lung). |
| LU Authorization Period: Up to 6 months | |
| 569 | For the prevention of Cytomegalovirus (CMV) in lung or heart-lung transplant patients. |
| LU Authorization Period: Up to 12 months |