Horizant — CareFirst (Caremark)

Preferred products

• pramipexole immediate-release
• ropinirole immediate-release

Initial criteria

• The request is for Horizant (gabapentin enacarbil extended-release).
• The patient has experienced an inadequate treatment response, intolerance, or has a contraindication to any of the following: pramipexole immediate-release or ropinirole immediate-release.

Reauthorization criteria

• The request is for Horizant (gabapentin enacarbil extended-release).
• The patient has achieved or maintained a positive clinical response to the requested drug.

Approval duration

12 months