JUBLIA (efinaconazole)

SELF ADMINISTRATION - TOPICAL

Indications for Prior Authorization:
  • Treatment of onychomycosis (tinea unguium) of the toenails due to Trichophyton rubrum or Trichophyton mentagrophytes.

Coverage criteria:
  • Medical record documentation confirms onychomycosis is medically necessary and not cosmetic in nature, AND

  • Treatment failure of at least one oral antifungal for onychomycosis (i.e. terbinafine, itraconazole, or alternative azole) AND ciclopirox nail lacquer 8% topical solution.

Dosing:
  • Apply one drop of Jublia onto the affected toenail once daily for 48 weeks. For the big toenail, a second drop may be necessary.

Coverage Duration:
  • 48 weeks

Authorization is Not Covered for the Following:
  • Non-FDA approved indications that are not listed in this policy do not meet the coverage criteria established by the Western Health Advantage (WHA) Pharmacy and Therapeutics Committee.

  • Cosmetic treatment of onychomycosis.

Last review date: September 11, 2020

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