Cuprimine — Medica
Cystinuria
Preferred products
- penicillamine capsules (generic)
Initial criteria
- According to the prescriber, patient has tried increased fluid intake; restriction of sodium and protein; and urinary alkalinization; AND
- Patient meets ONE of the following: (i) generic penicillamine capsules are requested; OR (ii) if brand Cuprimine is being requested, patient has tried generic penicillamine capsules AND cannot take generic penicillamine capsules due to a formulation difference in the inactive ingredient(s) (e.g., dyes, fillers, preservatives) which, per the prescriber, would result in a significant allergy or serious adverse reaction.
Approval duration
1 year