Osmolex ER — Medica

Preferred products

• amantadine immediate-release capsules
• amantadine immediate-release tablets
• amantadine oral solution

Initial criteria

• Patient has tried immediate-release amantadine capsules, tablets, or oral solution and meets ONE of the following: (a) patient derived benefit from immediate-release amantadine but had intolerable adverse events [documentation required]; OR (b) patient could not achieve a high enough dosage to gain adequate benefit [documentation required]
• Medication is prescribed by or in consultation with a neurologist

Reauthorization criteria

• Patient has tried immediate-release amantadine capsules, tablets, or oral solution and meets ONE of the following: (a) patient derived benefit from immediate-release amantadine but had intolerable adverse events [documentation required]; OR (b) patient could not achieve a high enough dosage to gain adequate benefit [documentation required]
• Patient has had a response to therapy (e.g., decrease in dyskinesia) as determined by the prescriber
• Medication is prescribed by or in consultation with a neurologist

Approval duration

initial 3 months; reauthorization 1 year