Gabarone (gabapentin) — Highmark
postherpetic neuralgia
Preferred products
- plan-preferred generic gabapentin immediate release
Initial criteria
- Member meets one (1) of the following criteria (1. or 2.):
- 1. Member meets all of the following criteria (a., b., and c.):
- a. age ≥ 3 years
- b. diagnosis of partial onset seizures (ICD-10: G40.0-G40.2)
- c. Gabarone is being used as adjunctive treatment
- OR
- 2. Member meets all of the following criteria (a. and b.):
- a. age ≥ 18 years
- b. diagnosis of postherpetic neuralgia (ICD-10: B02.23)
- AND
- Member has experienced therapeutic failure or intolerance to plan-preferred generic gabapentin immediate release
Reauthorization criteria
- Prescriber attests that the member has experienced positive clinical response to therapy
- AND
- Member has experienced therapeutic failure or intolerance to plan-preferred generic gabapentin immediate release
Approval duration
12 months