Cuvposa (glycopyrrolate oral solution) — Highmark
chronic severe drooling associated with neurologic conditions (e.g., cerebral palsy, mental retardation, stroke)
Preferred products
- glycopyrrolate oral solution (generic)
Initial criteria
- age between 3 and 16 years
- member has a neurologic condition associated with chronic, severe drooling (ICD-10 K11.7)
- if request is for brand Cuvposa, member has experienced therapeutic failure or intolerance to generic glycopyrrolate oral solution
Reauthorization criteria
- prescriber attests that the member has experienced positive clinical response to therapy
- if request is for brand Cuvposa, member has experienced therapeutic failure or intolerance to generic glycopyrrolate oral solution
Approval duration
12 months