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Amitiza (lubiprostone) — Blue Cross Blue Shield of Texas

Chronic Idiopathic Constipation (CIC)

Preferred products

  • Trulance (plecanatide)
  • Linzess (linaclotide)

Initial criteria

  • Diagnosis of CIC with symptoms ≥3 months
  • Requested agent is Amitiza (lubiprostone) or Motegrity (prucalopride)
  • AND ONE of the following: (A) BOTH of the following: (1) ONE of the following: (A) prescriber has stated the patient has stage four advanced metastatic cancer and agent is used to treat cancer OR (B) documentation of cancer and associated condition submitted AND (2) use is consistent with best practices, evidence-based literature, and FDA approval OR (B) patient tried and had inadequate response to ≥2 standard laxative classes (e.g., bulk forming, stimulant, enema, osmotic, stool softener) OR (C) intolerance/hypersensitivity to ≥2 standard laxative classes OR (D) FDA labeled contraindication to ALL standard laxative classes