pimavanserin — CareFirst (Caremark)
Hallucinations and delusions associated with Parkinson’s disease psychosis
Initial criteria
- Member has mild or no cognitive impairment as determined by the physician’s clinical diagnosis and/or cognitive impairment screening tests (e.g., Mini-Mental Status Examination [MMSE], Montreal Cognitive Assessment [MoCA])
Reauthorization criteria
- Member has experienced improvement in psychotic symptoms (hallucinations and/or delusions) since starting therapy
Approval duration
Initial: 6 months; Reauthorization: 12 months