Strattera (atomoxetine) — CareFirst (Caremark)
Attention Deficit Disorder (ADD)
Initial criteria
- For ADHD or ADD: The diagnosis has been appropriately documented (e.g., evaluated by a complete clinical assessment using DSM-5, standardized rating scales, interviews/questionnaires).
- If patient age ≤ 5 years, the patient continues to have ADHD/ADD symptoms despite participating in evidence‑based behavioral therapy (e.g., parent training in behavior management (PTBM), behavioral classroom interventions).
- For Narcolepsy: The patient has a confirmed diagnosis of narcolepsy by a sleep study.
- The requested drug is being prescribed by, or in consultation with, a sleep specialist.
Reauthorization criteria
- For ADHD or ADD: The patient achieved or maintained improvement in their signs and symptoms of ADHD/ADD from baseline, and the patient’s need for continued therapy has been assessed within the previous year.
- For Narcolepsy: The patient has achieved or maintained improvement in daytime sleepiness with narcolepsy from baseline.