Onapgo (apomorphine hydrochloride) injection — Highmark
treatment of motor fluctuations in adults with advanced Parkinson’s disease
Preferred products
- pramipexole
- ropinirole
- entacapone
- rasagiline
- selegiline
Initial criteria
- Diagnosis of Parkinson’s disease (ICD-10: G20)
- Parkinson’s disease is classified as advanced
- Using Onapgo for the treatment of motor fluctuations in adults
- Experiencing motor fluctuations despite an optimally dosed oral carbidopa/levodopa regimen
- Experienced therapeutic failure, intolerance, or contraindication to both of the following: pramipexole AND ropinirole
- Experienced therapeutic failure, intolerance, or contraindication to one of the following: entacapone OR rasagiline OR selegiline
Reauthorization criteria
- Prescriber attests that the member has experienced positive clinical response to therapy
Approval duration
12 months