Drizalma Sprinkle (duloxetine) — Highmark
Diabetic Peripheral Neuropathic Pain (DPNP)
Initial criteria
- age ≥ 18 years
- diagnosis of MDD, DPNP, or chronic musculoskeletal pain (ICD-10: F32-F33, E11.40, M79.1)
- inability to swallow capsules/tablets
Reauthorization criteria
- prescriber attests member has experienced positive clinical response to therapy
- prescriber attests member continues to have an inability to swallow capsules/tablets
Approval duration
12 months