Apokyn (apomorphine hydrochloride) injection — Highmark
acute, intermittent treatment of 'off' episodes associated with advanced Parkinson’s disease
Preferred products
- pramipexole
- ropinirole
- entacapone
- rasagiline
- selegiline
Initial criteria
- Diagnosis of Parkinson’s disease (ICD-10: G20)
- Parkinson’s disease is classified as advanced
- Using Apokyn for the acute, intermittent treatment of 'off' episodes
- Experiencing 'off' episodes despite an optimally dosed oral carbidopa/levodopa regimen
- Experienced therapeutic failure, intolerance, or contraindication to both of the following: pramipexole AND ropinirole
- Experienced therapeutic failure, intolerance, or contraindication to one of the following: entacapone OR rasagiline OR selegiline
- If the request is for brand Apokyn, experienced therapeutic failure or intolerance to generic apomorphine hydrochloride injection
Reauthorization criteria
- Prescriber attests that the member has experienced positive clinical response to therapy
- If the request is for brand Apokyn, experienced therapeutic failure or intolerance to generic apomorphine hydrochloride injection
Approval duration
12 months