Fleqsuvy (baclofen) oral suspension — Highmark
Spasticity, flexor spasms, pain, clonus, or muscular rigidity resulting from other spinal cord diseases
Preferred products
- Generic tizanidine tablets
- Generic baclofen tablets
Initial criteria
- age ≥ 12 years
- Diagnosis of spasticity, flexor spasms, pain, clonus, or muscular rigidity resulting from multiple sclerosis OR spinal cord injury OR other spinal cord diseases
- If age ≥ 18 years: therapeutic failure, contraindication, or intolerance to plan-preferred generic tizanidine tablets
- Therapeutic failure or intolerance to plan-preferred generic baclofen tablets
- Inability to swallow tablets
Reauthorization criteria
- Prescriber attests member has experienced positive clinical response to therapy
- Prescriber attests member continues to have an inability to swallow tablets
Approval duration
12 months