Vyalev (foscarbidopa/foslevodopa) — CareFirst (Caremark)
Treatment of motor fluctuations in adults with advanced Parkinson’s disease
Initial criteria
- Member has advanced Parkinson’s disease
- Member is levodopa responsive with clearly defined “on” periods
- Member has “off” periods of at least 2.5 hours per day despite optimization efforts
- Member has had an inadequate response or intolerable adverse event with oral carbidopa/levodopa and one of the following anti-Parkinson agents: Dopamine agonist (e.g., pramipexole, ropinirole) OR Monoamine oxidase-B (MAO-B) inhibitor (e.g., selegiline, rasagiline) OR Catechol-O-methyltransferase (COMT) inhibitor (e.g., entacapone, tolcapone)
Reauthorization criteria
- Member has demonstrated a positive clinical response with Vyalev for continued treatment of advanced Parkinson’s disease
Approval duration
Initial: 6 months; Continuation: 12 months