Drug - Rexulti™ (brexpipraxole) [Otsuka American Pharmaceutical, Inc.]
November 2015
Therapeutic area - Atypical Antipsychotics
The patient must meet criteria as follows:
The patient must meet all of the following criteria:
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 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.
MHCP Provider Call Center 651-431-2700 or 800-366-5411