Rebyota (fecal microbiota, live-jslm)
EVICORE-MEDICAL_DRUG-BB2D5661
Rebyota is covered only for adults (≥18) for the FDA‑approved indication of preventing recurrent C. difficile infection and is excluded for patients <18, non‑FDA uses, prior Rebyota recipients, and repeat dosing. Authorization requires documented CDI (≥3 loose stools/24 hrs for 2 consecutive days plus positive C. difficile toxin/toxigenic test), either ≥3 total CDI episodes or ≥2 severe CDI hospitalizations in the past year, current infection controlled after ≥10 consecutive days of antibiotics ( <3 loose stools/day for 2 consecutive days), and administration as a single 150 mL rectal dose given 24–72 hours after the last antibiotic with complete supporting documentation.
"Patients who have had at least 3 episodes of CDI (meets recurrence criteria)."
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