Limited coverage drugs – ziprasidone
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|
Generic name |
ziprasidone |
|---|---|
| Strength | 20 mg, 40 mg, 60 mg, 80 mg |
|
Form |
capsule |
|
Special Authority criteria |
Approval period |
|---|---|
|
Diagnosis of schizophrenia or other psychosis (not dementia-related) AND Treatment failure or intolerance to at least one other 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 ziprasidone automatically receive coverage for aripiprazole, brexpiprazole and olanzapine.
Special Authority requests
