Austedo — Highmark
Tardive Dyskinesia (TD)
Initial criteria
- age ≥ 18 years
- diagnosis of tardive dyskinesia (ICD-10: G24.01, G24.02, G24.09)
- prescriber attests that the member continues to experience symptoms of TD despite dose reduction, tapering, or discontinuation of the offending medication(s) OR dose reduction, tapering, or discontinuation of the offending medication(s) would not be appropriate
Reauthorization criteria
- prescriber attests that the member has experienced positive clinical response to therapy
Approval duration
12 months