Doxycycline Long-Acting Tablet formulations (e.g., Dorxy, Doryx MPC)

SELF ADMINISTRATION

FDA Approved Indications:
  • Treatment of susceptible infections
Prior authorization criteria:
  • Medically appropriate diagnosis, AND
  • Medically appropriate reason for use of the tablets and not the preferred agents is provided
  • Preferred agents include doxycycline monohydrate, doxycycline hyclate IR