Limited Coverage Drugs - risperidone microspheres

Generic Name

risperidone microspheres

Strength 

12.5 mg/2 mL, 25 mg/2 mL, 37.5 mg/2 mL, 50 mg/2 mL                                                                  

Form

injection

Special Authority Criteria

Approval Period

Management of the manifestations of schizophrenia or related psychotic disorders (not dementia-related) in:

  1. Patients who have tried oral risperidone, aripiprazole, or paliperidone

PLUS

at least one other antipsychotic agent

PLUS

continue to be inadequately controlled at maximally-tolerated doses

OR

  1. Patients who are currently receiving a conventional depot antipsychotic

PLUS

experiencing significant side effects such as extrapyramidal symptoms or tardive dyskinesia

OR

  1. Patients with a history of non-adherence to antipsychotic medications resulting in important negative outcomes such as repeated hospitalizations

Indefinite

Practitioner Exemptions

  • No practitioner exemptions

Special Notes

  • Coverage is not available for this formulation under Plan P

Special Authority Request Form