Zyprexa — CareFirst (Caremark)
bipolar disorder
Preferred products
- aripiprazole
- olanzapine
- quetiapine
- risperidone
- ziprasidone
Initial criteria
- Diagnosis of schizophrenia OR bipolar disorder OR major depressive disorder must be confirmed by the prescriber
- Prescriber must document an inadequate response, intolerance, or contraindication to at least two preferred atypical antipsychotic agents
Reauthorization criteria
- Documentation of clinical benefit from therapy (e.g., improvement or stabilization of symptoms)
- Absence of unacceptable toxicity or adverse effects
Approval duration
12 months