Limited coverage drugs – vortioxetine

Last updated on January 22, 2024

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Generic name		vortioxetine hydrobromide
Strength		5 mg, 10 mg, and 20 mg
Form		oral tablets

Special Authority criteria	Approval period
Major depressive disorder (MDD) in adult patients AND Treatment failure or intolerance to at least 2 other specified antidepressants for MDD treatment	Indefinite

Special Authority criteria

Approval period

Major depressive disorder (MDD) in adult patients

AND

Treatment failure or intolerance to at least 2 other specified antidepressants for MDD treatment

Indefinite

Practitioner exemptions

None

Special notes

Criteria applicable to all plans including Plan

Special Authority requests

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HLTH 5328 - Special Authority Request (PDF, 656KB)

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Limited coverage drugs – vortioxetine

Practitioner exemptions

Special notes

Special Authority requests