Rebyota® (Fecal Microbiota, Live-Jslm) – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers Rebyota for prevention of recurrent Clostridioides difficile infection in adults ≥18 as a single‑dose treatment only when all criteria are met: recurrent CDI with diarrhea (≥3 loose stools/day for 2 consecutive days) and a positive stool toxin test, ≥1 prior recurrence, completion of ≥10 days of oral vancomycin or fidaxomicin finished 24–72 hours before Rebyota, prior episode controlled (<3 unformed stools/day for 2 days), and prescribed by or in consultation with a gastroenterologist or infectious disease specialist (with supporting medical record documentation). Rebyota is not covered (considered unproven/not medically necessary) for other indications (e.g., ulcerative colitis, Crohn’s disease, IBS) or for initial CDI treatment.

"Prevention of recurrence of Clostridioides difficile infection (rCDI) in patients who meet all specified criteria (see below)."