Vyalev (foscarbidopa and foslevodopa subcutaneous injection – AbbVie) — Cigna

Initial criteria

• Patient is diagnosed with advanced Parkinson’s disease; AND
• Patient is experiencing “off” episodes such as muscle stiffness, slow movements, or difficulty starting movements; AND
• Patient has tried an oral carbidopa/levodopa therapy and meets ONE of the following (i or ii):
• i. Patient had significant intolerance, according to the prescriber; OR
• ii. Patient had inadequate efficacy, according to the prescriber; AND
• Patient has previously tried or is currently receiving ONE other treatment for “off” episodes (e.g., entacapone, rasagiline, pramipexole, ropinirole, tolcapone, cabergoline, selegiline, Ongentys [opicapone capsules], or Xadago [safinamide tablets]); AND
• The medication is prescribed by or in consultation with a neurologist.

Approval duration

1 year