Ongentys (opicapone) — Highmark
Parkinson’s disease experiencing 'off' episodes
Preferred products
- generic entacapone
- rasagiline
- pramipexole
- ropinirole
- selegiline
Initial criteria
- Diagnosis of Parkinson’s disease (ICD-10: G20)
- Ongentys will be used as an adjunct to carbidopa/levodopa
- Member is experiencing 'off' episodes between levodopa/carbidopa doses
- Member has experienced therapeutic failure, contraindication, or intolerance to the plan-preferred product generic entacapone
- Member has experienced therapeutic failure or intolerance to two (2) or contraindication to all of the following plan-preferred products: rasagiline, pramipexole, ropinirole, selegiline
Reauthorization criteria
- Prescriber attests that the member has experienced positive clinical response to therapy
- Member is using Ongentys as an adjunct to carbidopa/levodopa
Approval duration
12 months