Apokyn — CareFirst (Caremark)
Acute, intermittent treatment of 'off' episodes in patients with Parkinson’s disease
Initial criteria
- Member experiences at least 2 hours per day of 'off' time
- Member is currently being treated with carbidopa/levodopa
- Attempts to manage 'off' episodes by adjusting dosing or formulation of carbidopa/levodopa were ineffective
- Treatment with carbidopa/levodopa plus one of the following was ineffective at managing 'off' episodes: dopamine agonist (e.g., pramipexole, ropinirole) OR monoamine oxidase-B (MAO-B) inhibitor (e.g., selegiline, rasagiline) OR catechol-O-methyltransferase (COMT) inhibitor (e.g., entacapone, tolcapone)
Reauthorization criteria
- Member is currently being treated with carbidopa/levodopa
- Member is experiencing improvement with the requested medication (e.g., reduction in daily 'off' time, improvement in motor function post-administration)
Approval duration
Initial: 6 months; Reauthorization: 12 months