Limited Coverage Drugs - Aripiprazole
Generic Name |
aripiprazole |
---|---|
Strength | 2 mg, 5 mg, 10 mg, 15 mg, 20 mg, 30 mg |
Form |
tablet |
Special Authority Criteria |
Approval Period |
---|---|
Patient specific diagnosis identified as Schizophrenia or other psychosis (not dementia related) AND Treatment failure or intolerance to at least one other specified anti-psychotic agent. |
Indefinite |
Practitioner Exemptions
- None
Special Notes
- Criteria applicable for all plans including Plan G.
- Patients who meet Schizophrenia diagnosis criteria for aripiprazole automatically receive coverage for brexpiprazole, olanzapine and ziprasidone.