The formulary status of antiviral agents for SFHP Medi-Cal, Healthy Families and Healthy Kids programs are aligned with FDA-approved dosing and WHO Guidelines for the Treatment of H1N1 and other influenza viruses.  According to the WHO Guidelines, the following high-risk populations should be considered for treatment:

• Infants and children younger than 5 years old
• Adults older than 65 years old
• Nursing home residents
• Patients with a chronic, comorbid disease (e.g. immunosuppresed, diabetes)

For requests that do not meet the criteria indicated below (e.g. chemoprophylaxis, conditions that are not detected through pharmacy claims), please submit a prior authorization request.