Zelapar (selegiline orally disintegrating tablets) — Cigna

Initial criteria

• Patient is experiencing 'off' episodes (examples include muscle stiffness, slow movements, or difficulty starting movements); AND
• Patient is currently receiving carbidopa/levodopa therapy; AND
• Patient has tried one of oral selegiline tablets, selegiline capsules, or rasagiline tablets AND meets ONE of the following (i or ii):
• i. Patient had significant intolerance, according to the prescriber; OR
• ii. Patient has difficulty swallowing tablets or capsules; AND
• Zelapar is being prescribed by or in consultation with a neurologist.

Approval duration

1 year