milnacipran — CareFirst (Caremark)

Preferred products

• duloxetine
• pregabalin

Initial criteria

• The patient is age ≥ 18 years
• The requested drug is being prescribed for the management of fibromyalgia
• The patient has experienced an inadequate treatment response to duloxetine OR the patient has experienced an intolerance to duloxetine OR the patient has a contraindication that would prohibit a trial of duloxetine

Reauthorization criteria

• The patient is age ≥ 18 years
• The requested drug is being prescribed for the management of fibromyalgia
• The patient has achieved or maintained a positive clinical response to the requested drug (e.g., improvement in pain)

Approval duration

Initial therapy: 6 months; Continuation: 36 months