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Aplenzin — Cigna

Major depressive disorder and other plan-covered antidepressant indications per policy Step Therapy

Preferred products

  • generic bupropion extended-release tablets
  • generic bupropion sustained-release tablets
  • generic citalopram oral solution
  • generic citalopram tablets
  • generic duloxetine delayed-release (20 mg, 30 mg, 60 mg) capsules
  • generic escitalopram tablets
  • generic fluoxetine immediate-release capsules
  • generic fluoxetine oral solution
  • generic fluvoxamine immediate-release tablets
  • generic paroxetine HCl immediate-release tablets
  • generic sertraline oral solution
  • generic sertraline tablets
  • generic venlafaxine extended-release capsules
  • generic venlafaxine immediate-release tablets

Initial criteria

  • STANDARD CRITERIA apply:
  • 1. If the patient has tried one Step 1 Product, approve a Step 2 Product.
  • 2. If the patient is currently taking or has taken Desvenlafaxine extended-release tablets (brand product), desvenlafaxine succinate extended-release tablets (Pristiq or generics), Fetzima, Pexeva, vilazodone hydrochloride tablets (Viibryd or generics), or Trintellix at any time in the past and discontinued its use, approve the Product that they have used.
  • 3. If the patient cannot swallow or has difficulty swallowing tablets or capsules, approve generic escitalopram oral solution or generic paroxetine HCl oral suspension.
  • 4. If the patient has suicidal ideation, approve Desvenlafaxine extended-release tablets (brand product), desvenlafaxine succinate extended-release tablets (Pristiq or generics), Fetzima, Pexeva, vilazodone hydrochloride tablets (Viibryd or generics), or Trintellix.
  • HIGH IMPACT CRITERIA apply:
  • 1. If the patient has tried two Step 1 Products, approve a Step 2 Product.
  • 2. If the patient is currently taking or has taken Desvenlafaxine extended-release tablets (brand product), desvenlafaxine succinate extended-release tablets (Pristiq or generics), Fetzima, Pexeva, vilazodone hydrochloride tablets (Viibryd or generics), or Trintellix at any time in the past and discontinued its use, approve the Product that they have used.
  • 3. If the patient cannot swallow or has difficulty swallowing tablets or capsules, approve generic escitalopram oral solution or generic paroxetine HCl oral suspension.
  • 4. If the patient has suicidal ideation, approve Desvenlafaxine extended-release tablets (brand product), desvenlafaxine succinate extended-release tablets (Pristiq or generics), Fetzima, Pexeva, vilazodone hydrochloride tablets (Viibryd or generics), or Trintellix.

Approval duration

1 year