Xadago (safinamide) — Highmark
Parkinson’s disease experiencing 'off' episodes
Preferred products
- generic rasagiline
- selegiline
- pramipexole
- ropinirole
- entacapone
Initial criteria
- age ≥ 18 years
- diagnosis of Parkinson’s disease (ICD-10: G20)
- Xadago will be used as an adjunct to levodopa/carbidopa
- member is experiencing wearing off (e.g., 'off' episodes) despite optimized levodopa/carbidopa therapy
- member has experienced therapeutic failure, contraindication, or intolerance to generic rasagiline
- member has experienced therapeutic failure, contraindication, or intolerance to two of the following: selegiline, pramipexole, ropinirole, entacapone
Reauthorization criteria
- prescriber attests that the member has experienced positive clinical response to therapy
Approval duration
12 months