Pharmacy Prior Authorization Criteria

Rezzayo (rezafungin)

Indications for Prior Authorization

Rezzayo (rezafungin)

• For diagnosis of Candidemia and invasive candidiasis
  Indicated in patients 18 years of age or older who have limited or no alternative options for the treatment of candidemia and invasive candidiasis. Approval of this indication is based on limited clinical safety and efficacy data for Rezzayo.

  Limitations of Use Rezzayo has not been studied in patients with endocarditis, osteomyelitis, and meningitis due to Candida.

Criteria

Rezzayo

Prior Authorization

Length of Approval: 1 Month(s)

• Diagnosis of candidemia or invasive candidiasis with limited or no alternative options
AND
• Patient is 18 years of age or older
AND
• Trial and failure, contraindication or intolerance to one of the following [2]:
• generic caspofungin
• generic micafungin

P & T Revisions

2024-08-21, 2023-09-05

References

1. Rezzayo Prescribing Information. Melinta Therapeutics LLC. Lincolnshire, IL. June 2023.
2. Peter G. Pappas, Carol A. Kauffman, David R. Andes, Cornelius J. Clancy, Kieren A. Marr, Luis Ostrosky-Zeichner, Annette C. Reboli, Mindy G. Schuster, Jose A. Vazquez, Thomas J. Walsh, Theoklis E. Zaoutis, Jack D. Sobel, Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America, Clinical Infectious Diseases, Volume 62, Issue 4, 15 February 2016, Pages e1–e50, https://doi.org/10.1093/cid/civ933

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Revision History

• 2024-08-21: 2024 UM Annual Review. No changes. Background updates.
• 2023-09-05: New program for Rezzayo

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