Primary navigation

    Rexulti

    Drug - Rexulti™ (brexpipraxole) [Otsuka American Pharmaceutical, Inc.]

    November 2015

    Therapeutic area - Atypical Antipsychotics

    Approval criteria – Schizophrenia

    The patient must meet criteria as follows:

    • Has been stabilized on Rexulti (the drug is part of the recipient's current course of treatment) as covered on a previous health insurance plan, and patient is new to Medical Assistance (MA) OR
    • Was started and stabilized on Rexulti in an acute care setting, such as during a hospitalization or within another place of care that offers acute care services OR
    • Is 18 years of age or older and has a diagnosis of schizophrenia and has failed to respond to, or experiences intolerable side effects to adequate trials of risperidone and aripiprazole

    Approval criteria – Major depressive disorder

    The patient must meet all of the following criteria:

    • Is 18 years of age or older 
    • Has a diagnosis of major depressive disorder 
    • Has tried and failed two separate two-month trials of two preferred SSRIs (see table below)
    • Has a documented intolerance or contraindication to or has tried and failed a two-month trial of one other preferred new generation antidepressant (i.e. venlafaxine, bupropion, mirtazapine or a tri-cyclic antidepressant) (see table below)
    • Will be taking another antidepressant concurrently with Rexulti

    Selective Serotonin Reuptake Inhibitors (SSRI)

    Preferred Nonpreferred
    citalopram
    escitalopram    		 Celexa
    fluoxetine Lexapro
    Paxil/Paxil CR
    paroxetine Prozac
    Pexeva Fluoxetine DR (weekly)
    Prozac Weekly
    sertraline paroxetine suspension
    Sarafem
    Viibryd (individual PA criteria apply)
    Zoloft

    New Generation Antidepressants

    Preferred Nonpreferred
    bupropion IR, SA, XL Aplenzin* (bupropion HBr)
    fluvoxamine Cymbalta
    mirtazapine Desyrel
    nefazodone Effexor, Effexor XR
    trazodone Luvox CR*
    venlafaxine extended release Pristiq*
    venlafaxine extend release capsules (generic Effexor XR) Remeron
    venlafaxine extended release tablets (generic) Wellbutrin/ SR / XL
    * individual PA criteria apply

    Quantity limits

    Quantity Limit = 34 (All strengths)

    Dosing for major depressive disorder will be limited to 3 mg once daily; dosing for schizophrenia will be limited to 4 mg once daily.

    Questions?

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

    back to top