Bonjesta (doxylamine succinate and pyridoxine hydrochloride) — Highmark
nausea and vomiting in pregnancy
Initial criteria
- Diagnosis of nausea and vomiting in pregnancy (ICD-10: O21)
- Member has experienced therapeutic failure or intolerance to the individual products of OTC doxylamine succinate and OTC pyridoxine hydrochloride (vitamin B6), available separately yet taken together
Approval duration
9 months