Horizant (gabapentin enacarbil) — Highmark
Post-Herpetic Neuralgia (PHN)
Preferred products
- generic gabapentin
Initial criteria
- age ≥ 18 years
- diagnosis of PHN (ICD-10: B02.23)
- therapeutic failure or intolerance to plan preferred generic gabapentin
Reauthorization criteria
- prescriber attests that the member has experienced positive clinical response to therapy
Approval duration
12 months