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Limited coverage criteria – lurasidone

Last updated on April 2, 2025

 

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Generic name

lurasidone

Strength & form

20 mg, 40 mg, 60 mg, 80 mg, 120 mg tablet

Special Authority criteria

Approval period

For the management of schizophrenia in patients with treatment failure or intolerance to at least one anti-psychotic agent1

Indefinite

For the management of bipolar I disorder, as monotherapy in patients:

  • Aged 13 years or older

AND

  • Who have experienced or are experiencing a major depressive episode
 Indefinite

For the management of bipolar I disorder, as adjunct therapy with lithium or valproate in patients:

  • Aged 18 years or older

AND

  • Who have experienced or are experiencing a major depressive episode

AND

  • Who have an inadequate response or intolerance with lithium or divalproex sodium
 Indefinite

Practitioner exemptions

  • None

Special notes

  • 1Details of anti-psychotic agent(s) previously tried must be documented in the Special Authority request form
  • Patients currently enrolled in Plan G require Special Authority for approval

Special Authority request form(s)