Syndros (dronabinol) oral solution — Highmark

Preferred products

• generic dronabinol capsules

Initial criteria

• age ≥ 18 years
• diagnosis of anorexia associated with weight loss due to AIDS (ICD-10: R64)
• prescriber provides documentation of the member’s initial weight
• therapeutic failure, contraindication, or intolerance to plan-preferred generic dronabinol capsules

Reauthorization criteria

• prescriber submits documentation of increase in weight from baseline

Approval duration

12 months