Fda approved indications1-3

Antidepressant Agents
Step Therapy Criteria



OBJECTIVE
The intent of the Antidepressant Agents Step Therapy program is to encourage the use of
generic antidepressant agents - selective serotonin reuptake inhibiting agents (SSRIs),
serotonin norepinephrine reuptake inhibiting agents (SNRIs), bupropion/bupropion
extended-release, mirtazapine, or trazodone extended-release - prior to brand
antidepressant agents and to accommodate for use of brand antidepressant agents when
generic prerequisite agents cannot be used due to previous trial, documented intolerance,
FDA labeled contraindication, or hypersensitivity. The criteria for Cymbalta also encourage
its use for neuropathic pain after trial of amitriptyline, nortriptyline, imipramine,
desipramine, or gabapentin, for fibromyalgia (FM) after a trial of amitriptyline, nortriptyline,
imipramine, desipramine, cyclobenzaprine, tramadol, or gabapentin, and for chronic
musculoskeletal pain (CMP; for example, osteoarthritis or chronic low back pain) after a trial
of acetaminophen, oral NSAID, topical NSAID, or any other prerequisite for FM or
neuropathic pain already listed. Requests for brand antidepressant agents will be reviewed
when patient-specific documentation has been provided.


TARGET DRUGS
Aplenzin™
(bupropion)
Brintellix™ (vortioxetine)
Celexa®
(citalopram)a
Cymbalta® (duloxetine)b
Khedezla®
(Desvenlafaxine ER tablets, brand product)
Effexor® (venlafaxine)a
Effexor XR® (venlafaxine extended-release)a
Fetzima™ (levomilnacipran extended-release)
Fluoxetine 60 mg
(tablets, brand product)
Forfivo XL® (bupropion extended–release)
Lexapro® (escitalopram)a
Luvox CR® (fluvoxamine extended-release)a
Maprotiline (tablets, brand product)
Oleptro™ (trazodone extended-release)b
Paxil® (paroxetine hydrochloride)a
Paxil CR® (paroxetine extended-release)a
Pexeva® (paroxetine mesylate)
Pristiq® (desvenlafaxine)
Prozac® (fluoxetine)a
Prozac® Weekly™ (fluoxetine delayed-release)a
Remeron® (mirtazapine)a
RemeronSolTab® (mirtazapine)a
Venlafaxine ER (tablets, brand product)a
Viibryd™ (vilazodone)
Wellbutrin® (bupropion)a
Wellbutrin SR® (bupropion extended-release)a
Wellbutrin XL® (bupropion extended-release)a
Zoloft® (sertraline)a
a - available as a generic; generic included as a prerequisite in step therapy program
MT_PS_Antidepressant_ST_ AR0613_1113.doc Copyright Prime Therapeutics LLC. 11/2013 All Rights Reserved b – generic anticipated in 2013; generic will be included as a prerequisite in step therapy program MT_PS_Antidepressant_ST_ AR0613_1113.doc Copyright Prime Therapeutics LLC. 11/2013 All Rights Reserved PRIOR AUTHORIZATION CRITERIA FOR APPROVAL
Brand Antidepressant Agents
(except Cymbalta, see below) will be approved when BOTH
of the following are met:
The patient has not filled a prescription for a monoamine oxidase (MAO) inhibitor in
the past 30 days
AND
The patient’s medication history includes use of a generic SSRI, SNRI,
bupropion, mirtazapine, or trazodone extended-release OR
There is documentation that the patient is currently using the requested
brand antidepressant OR
The prescribing physician states the patient is using the requested brand
antidepressant AND is at risk if therapy is changed OR
The patient has a history of a documented intolerance, FDA labeled contraindication, or hypersensitivity to a generic SSRI, SNRI, bupropion, mirtazapine, or trazodone extended-release
Cymbalta will be approved when BOTH of the following are met:
The patient has not filled a prescription for a monoamine oxidase (MAO) inhibitor in
the past 30 days
AND
The patient’s medication history includes use of a generic SSRI, SNRI,
bupropion, mirtazapine, or trazodone extended-release OR
The patient has a diagnosis of neuropathic pain and the medication history
includes use of amitriptyline, nortriptyline, desipramine, imipramine, or
gabapentin OR
The patient has a diagnosis of fibromyalgia and the medication history
includes use of amitriptyline, nortriptyline, desipramine, imipramine,
cyclobenzaprine, gabapentin, or tramadol OR
The patient has a diagnosis of chronic musculoskeletal pain and the
medication history includes use of acetaminophen, oral NSAID, topical NSAID,
tramadol, amitriptyline, nortriptyline, desipramine, imipramine,
cyclobenzaprine, or gabapentin OR
There is documentation that the patient is currently using Cymbalta
(duloxetine) OR
The prescribing physician states the patient is using Cymbalta (duloxetine)
AND is at risk if therapy is changed OR
The patient has a history of a documented intolerance, FDA labeled contraindication, or hypersensitivity to a prerequisite for the requested diagnosis

Length of approval:
12 months


MT_PS_Antidepressant_ST_ AR0613_1113.doc Copyright Prime Therapeutics LLC. 11/2013 All Rights Reserved

Source: https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/primepharmacypolicies/Antidepressant_ST_ProgSum.pdf

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