Cedax, Ceclor, Ceclor CD, Ceftin, Cefzil, Duricef, Fortaz, Keflex, Lorabid, Omnicef, Panixine, Raniclor, Rocephin, Spectracef, Suprax and Vantin are currently Not Covered Part D drugs under the Aetna Medicare Prescription Drug Plan.* Therefore, they are excluded from coverage for members enrolled in prescription drug benefit plans that use a closed formulary, unless a medical exception is granted.  Aetna considers Cedax, Ceclor, Ceclor CD, Ceftin, Cefzil, Duricef, Fortaz, Keflex, Lorabid, Omnicef, Panixine, Raniclor, Rocephin, Spectracef, Suprax and Vantin to be medically necessary for those members who meet any of the following criteria:

For Cedax, Ceclor, Ceclor CD, Ceftin, Cefzil, Duricef, Fortaz, Keflex, Lorabid, Omnicef,  Panixine, Raniclor, Spectracef, Suprax and Vantin

A.  A documented:

• Contraindication to two covered alternatives indicated for the member's condition (see table below), one of which was a covered cephalosporin OR,
• Intolerance to two covered alternatives indicated for the member's condition (see table below), one of which was a covered cephalosporin OR,
• Allergy to two covered alternatives indicated for the member's condition (see table below), one of which was a covered cephalosporin OR,
• Documented lack of bacterial sensitivity to two covered alternatives indicated for the member's condition (see table below), one of which was a covered cephalosporin OR,
• Failure of an adequate trial of 3 days each of two covered alternatives indicated for the member's condition (see table below), one of which was a covered cephalosporin.

For Rocephin inj

A documented:

• Contraindication to the covered generic equivalent OR,
• Intolerance to the covered generic equivalent OR,
• Allergy to the covered generic equivalent OR
• Failure of an adequate trial of 3 days of the covered generic equivalent.