Anti-Infectives

miconazole buccal tablets (Oravig®)

PA Criteria:

FDA-approved diagnosis of oropharyngeal candidiasis in adults age 18 and older.
Recent trials (within the last month) of the following medications at recommended dosing and duration of therapy:
- Clotrimazole troches, AND
- Nystatin suspension, AND
- Fluconazole tablets
Contraindication(s) to all available alternative medications.

Prior Authorization Form

Last Modified on Jun 16, 2021

Oklahoma Health Care Authority

4345 N Lincoln Blvd

Oklahoma City, OK 73105

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