Rebyota™ (fecal microbiota, live-jslm)
EVICORE-MEDICAL_DRUG-0C6B8358
Rebyota is covered only for adults ≥18 to prevent recurrent C. difficile infection after antibiotic therapy, limited to one 150 mL rectal dose given 24–72 hours after the last antibiotic dose, and is excluded for primary/initial CDI, non-recurrent indications, prior Rebyota recipients, or dosing outside the 24–72 hour window. Coverage requires documented age, confirmed CDI (≥3 loose stools within 24 hours for 2 consecutive days plus a positive C. difficile stool test), either ≥3 prior CDI episodes or ≥2 severe hospitalizing episodes in the past year, current CDI controlled after ≥10 days of antibiotics ( <3 loose stools/day for 2 consecutive days), documentation of last antibiotic dose, and records of the planned/actual single 150 mL rectal administration.
"Rebyota is indicated for the prevention of recurrence of Clostridioides difficile infection (CDI) in individuals 18 years of age and older following antibiotic treatment for recurrent CDI."