Limited Coverage Drugs - Brexpiprazole
|
Generic Name |
brexpiprazole |
|---|---|
| Strength | 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 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 requirements for brexpiprazole automatically receive coverage for aripiprazole, olanzapine and ziprasidone.
