Motegrity (prucalopride) — Blue Cross Blue Shield of Oklahoma
chronic idiopathic constipation (CIC)
Preferred products
- Trulance (plecanatide)
- Linzess (linaclotide)
Initial criteria
- Patient has diagnosis of chronic idiopathic constipation (CIC) AND symptoms for ≥3 months
- Requested agent is Amitiza (lubiprostone) or Motegrity (prucalopride)
- AND ONE of the following: BOTH of the following: prescriber statement or documentation of stage four advanced metastatic cancer AND agent use consistent with best practices and FDA approval OR patient has tried and had inadequate response to ≥2 standard laxative therapy classes OR patient has intolerance or hypersensitivity to ≥2 standard laxative therapy classes OR patient has FDA labeled contraindication to ALL standard laxative therapy classes