Reimbursement Support

Your patient has been prescribed DIFICIDDIFICID® is a 200 mg oral antibacterial drug that acts locally in the gastrointestinal tract against C. difficile...® for your patients.

Your patient's next question might be: "Will my insurance cover it?" Or "How will I pay for it?"

You know how important it is to manage your patient’s expectations about insurance co-pays and benefits details. Here you will find resources related to reimbursement that may be useful to you and your patients.

Below you will find an example Prior Authorization Form, Denial Letter, and Appeal Letter. These forms can be downloaded for your education, but note that these sample forms are examples only. Also available are the DIFICIDDIFICID® is a 200 mg oral antibacterial drug that acts locally in the gastrointestinal tract against C. difficile... Dosing Guidelines. Click the links below to download.

NOTE: Only members of DIFICIDDischarge.com can access the documents below. Click here to sign up now.

 

Sample Prior Authorization Form

Click here to
download the Sample Prior Authorization
Form.

Download PDF

Sample Denial Letter

Click here to
download the Sample Denial Letter.

 

 Download PDF 

Sample Appeal Letter

Click here to
download the Sample Appeal Letter.

 

Download PDF

DIFICID Dosing Guidelines

Click here to
download the DIFICID Dosing Guidelines.

 

Download PDF

DIFICID Rx Assist™ helps facilitate a continuum of care by supporting patient access to DIFICID as they transition from an inpatient to outpatient setting. DIFICID Rx Assist performs benefits investigations, advanced notification of out-of-pocket costs and prior authorization (PA) management.

 

 

Important Safety Information

  • DIFICID is contraindicated in patients with hypersensitivity to fidaxomicin
  • DIFICID should not be used for systemic infections
  • Acute hypersensitivity reactions (angioedema, dyspnea, pruritus, and rash) have been reported. In the event of a severe reaction, discontinue DIFICID.
  • Only use DIFICID for infection proven or strongly suspected to be caused by C. difficile.
    Prescribing DIFICID in the absence of a proven or strongly suspected C. difficile infection is unlikely to provide benefit to the patient and increases the risk of the development of drug- resistant bacteria.
  • The most common adverse reactions reported in clinical trials are nausea (11%), vomiting (7%), abdominal pain (6%), gastrointestinal hemorrhage (4%), anemia (2%), and neutropenia (2%)

Indication and Usage

  • DIFICID is a macrolide antibacterial drug indicated in adults ≥ 18 years of age for treatment of Clostridium difficile-
    associated diarrhea
  • To reduce the development of drug-resistant bacteria and maintain the effectiveness of DIFICID and other
    antibacterial drugs, DIFICID should be used only to treat infections that are proven or strongly suspected
    to be caused by Clostridium difficile

Please click here for full prescribing information for DIFICID