Movantik

Drug - Movantik™ (naloxegol oxalate tablets) [AstraZeneca]

March 2018

Therapeutic area - Opioid induced constipation

Approval criteria

Patient is at least 18 years of age
Patient is diagnosed with opioid-induced constipation (OIC) related to chronic non-cancer pain AND
Patient is currently on opioids
Patient has been using opioids for at least 75 days within the past 90 days AND
Patient has not tolerated or has had inadequate response to one-month trials of a stimulant laxative (e.g., bisacodyl; sennosides) AND polyethylene glycol 3350 OR other osmotic laxative (e.g., sorbitol, lactulose, magnesium citrate, magnesium hydroxide, glycerin rectal suppositories) as documented in pharmacy fill history or other documentation indicating fill/refill history if patient is new to Medical Assistance and pharmacy claims data is not readily available AND
Patient has not tolerated or has had inadequate response to a one-month trial of Amitiza OR
Patient’s OIC is due to diphenylheptane opioids (e.g., methadone) AND
Patient does not have ANY of the following conditions:
- Known or suspected gastrointestinal obstruction OR
- Pregnancy OR
- Severe hepatic impairment (Child-Pugh Class C)

Maximum one tablet daily (34 tablets per 34 days)

MHCP Provider Call Center 651-431-2700 or 800-366-5411