Diagnosis: Bacterial Intestinal Infection And Irritable Bowel Syndrome
Treatment: Xifaxan 550mg
The insurer denied the Xifaxan 550mg.
The denial is upheld.

The patient is a male whose request for XIFAXAN 550 milligrams (MG) (rifaximin) is under review. The patient has a history of human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), Kaposi sarcoma, and CD4 (cluster of differentiation 4) nadir of 350 cells/ul. The patient also suffers from small intestinal bacterial overgrowth. The patient is currently taking BIKTARVY, boosted darunavir and maraviroc, and HIV is well-controlled. The patient has a history of abdominal bloating and diarrhea and was diagnosed with small intestinal bacterial overgrowth; he is currently undergoing treatment with XIFAXAN 550MG (rifaximin).

No, the proposed treatment with XIFAXAN is not medically necessary.

Currently, this medication is not approved for small bowel intestinal overgrowth, although some studies have shown a benefit in the use of this medication and this is the most studied medication for this condition (1). Most studies have studied up to one month of treatment (1). The patient is currently on this antibiotic, but no information is given on current symptoms, response to treatment, if the medication is to be used prophylactically or symptomatically, and duration of the proposed treatment, etc. As such, the medication cannot be approved.