Lybalvi — CareFirst (Caremark)
maintenance treatment of bipolar I disorder
Preferred products
- aripiprazole
- asenapine
- lurasidone
- olanzapine
- paliperidone
- quetiapine
- quetiapine extended-release
- risperidone
- ziprasidone
Initial criteria
- Patient has experienced an inadequate treatment response after a trial of at least 30 days to ONE of the following generic products: aripiprazole, asenapine, lurasidone, olanzapine, paliperidone, quetiapine, quetiapine extended-release, risperidone, ziprasidone.
- OR patient has an intolerance or a contraindication that would prohibit a 30-day trial of ONE of the following generic products: aripiprazole, asenapine, lurasidone, olanzapine, paliperidone, quetiapine, quetiapine extended-release, risperidone, ziprasidone.
- OR patient has a clinical condition for which there is no generic alternative or the generic alternatives are not recommended based on published guidelines or clinical literature.
Reauthorization criteria
- Patient is currently taking the requested drug with evidence of improvement.
Approval duration
36 months