Relistor tablets — Cigna
opioid-induced constipation in adults with advanced illness receiving palliative care
Preferred products
- Movantik
- Symproic
Initial criteria
- Patient has tried TWO Step 1 Products (Movantik, Symproic) AND requesting a Step 2 Product (Relistor tablets or Relistor injection).
- OR Relistor injection is being prescribed for the treatment of opioid-induced constipation in an adult patient with advanced illness who is receiving palliative care.
Approval duration
1 year