Adzenys ER — CareFirst (Caremark)
Attention Deficit Disorder (ADD)
Initial criteria
- Diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD) or Attention Deficit Disorder (ADD) has been appropriately documented (e.g., evaluated by a complete clinical assessment, using DSM-5, standardized rating scales, interviews/questionnaires).
- If patient age ≤ 5 years, ADHD/ADD symptoms persist despite participation in evidence-based behavioral therapy (e.g., parent training in behavior management, behavioral classroom interventions).
- For narcolepsy: request is NOT for amphetamine extended-release (Adzenys ER, Adzenys XR-ODT), amphetamine-dextroamphetamine extended-release (Adderall XR), amphetamine sulfate orally disintegrating tablet (Evekeo ODT), methylphenidate chewable tablet, methylphenidate immediate release, methylphenidate extended-release (Aptensio XR, Concerta, Cotempla XR-ODT, methylphenidate CD, Methylphenidate Osmotic Extended-Release, Relexxii, Ritalin LA), dexmethylphenidate (Focalin), or dexmethylphenidate extended-release (Focalin XR).
- For narcolepsy: drug is prescribed by, or in consultation with, a sleep specialist.
- For narcolepsy: diagnosis confirmed by a sleep study.
Reauthorization criteria
- For ADHD/ADD: patient has achieved or maintained improvement in signs and symptoms from baseline AND need for continued therapy assessed within the previous year.
- For narcolepsy: request is NOT for excluded products listed under initial criteria.
- For narcolepsy: patient has achieved or maintained improvement in daytime sleepiness with narcolepsy from baseline.