Limited Use Note(s)

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