Journavx (suzetrigine) — Highmark

Initial criteria

• age ≥ 18 years
• diagnosis of moderate-to-severe acute pain (ICD-10: R52)
• prescriber attests that the episode of acute pain is anticipated to last less than one (1) month
• prescriber attests that the treatment of pain is not amenable to conservative measures such as acetaminophen, NSAIDs, and non-pharmacologic measures

Reauthorization criteria

• prescriber attests that the member is experiencing a new episode of moderate-to-severe acute pain, separate and distinct from the previous episode
• prescriber attests that the new episode of acute pain is anticipated to last less than one (1) month
• prescriber attests that the treatment of pain is not amenable to conservative measures such as acetaminophen, NSAIDs, and non-pharmacologic measures

Approval duration

up to 14 days per episode