Crofelemer (Fulyzaq®)


Indications for Prior Authorization:

  • Approvable for relief of non-infectious diarrhea

Patients must meet the following criteria for the indication(s) above:

  • Diagnosis of HIV or AIDS
  • Must be on antiretroviral therapy

The Following Conditions Do Not Meet the Criteria for Use as Established by the WHA P & T Committee:

  • All non-FDA approved uses not listed in the approved indications

Recommended Dosing:

  • 125 mg twice a day with food


  • Initial approval 4 weeks
  • Renewal: One year (with documented effectiveness)


Last review date: December 2, 2013

The site you are transferring to is not hosted by WHA. WHA's Terms of Use and internet Privacy Practices do not apply to your use of this linked site. Please review the policies on privacy and terms of use for the linked site. WHA does not control the accuracy, completeness, or timeliness of the content on the linked site.