Xofluza™
Drug - Xofluza™ (baloxavir) [Genentech, Inc.]
June 2019
Therapeutic Area - Antivirals
Approval criteria
- Patient must be 12 years of age or older AND
- Patient must be at least 40 kg AND
- Patient must have acute, uncomplicated influenza AND
- Patient has been symptomatic for no more than 48 hours AND
- Patient is:
- NOT on concurrent neuraminidase inhibitors (e.g., Tamiflu, Relenza) AND
- NOT pregnant AND
- NOT hospitalized AND
- Xofluza is NOT prescribed for influenza prophylaxis AND
- If patient is 12 years of age or older, prescriber must provide a reason oseltamivir is not clinically appropriate for the patient (i.e., the convenience of the patient, prescriber, or other health care provider will not be considered)
Quantity limits
- 40 mg dose: one 2 x 20 mg blister card OR
- 80 mg dose: one 2 x 40 mg blister card AND
- Patient’s body weight (in kg) must be provided at time of request
Questions?
MHCP Provider Call Center 651-431-2700 or 800-366-5411