Horizant — CareFirst (Caremark)
Adjunctive therapy for the treatment of partial-onset (focal-onset) seizures in patient 1 month to up to 3 years of age
Preferred products
- gabapentin immediate-release
Initial criteria
- The request is for Lyrica (pregabalin immediate-release).
- The requested drug is being prescribed for one of the listed indications.
- If the request is for Lyrica oral solution, the patient has difficulty swallowing oral solid dosage forms (e.g., capsules) OR requires a dose that cannot be obtained using the commercially available capsules.
Reauthorization criteria
- The request is for Lyrica (pregabalin immediate-release).
- The requested drug is being prescribed for one of the listed indications.
- If the request is for Lyrica oral solution, the patient has difficulty swallowing oral solid dosage forms (e.g., capsules) OR requires a dose that cannot be obtained using the commercially available capsules.
- The patient has achieved or maintained a positive clinical response to the requested drug.
Approval duration
12 months