Intuniv — CareFirst (Caremark)

Preferred products

• amphetamine products (e.g., amphetamine, amphetamine-dextroamphetamine, dextroamphetamine, methamphetamine, lisdexamfetamine)
• methylphenidate products (e.g., methylphenidate, dexmethylphenidate)

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).
• The patient has experienced an inadequate treatment response to an amphetamine product (e.g., amphetamine, amphetamine-dextroamphetamine, dextroamphetamine, methamphetamine, lisdexamfetamine) OR a methylphenidate product (e.g., methylphenidate, dexmethylphenidate) OR the patient has experienced an intolerance to an amphetamine product OR a methylphenidate product OR the patient has a contraindication that would prohibit a trial of an amphetamine product AND a methylphenidate product.

Reauthorization criteria

• The patient has achieved or maintained improvement in their signs and symptoms of ADHD/ADD from baseline.
• The patient's need for continued therapy has been assessed within the previous year.

Approval duration

36 months