sertraline capsules — Medica
major depressive disorder
Preferred products
- generic bupropion extended-release tablets
- generic bupropion sustained-release tablets
- generic citalopram oral solution
- generic citalopram tablets
- generic duloxetine delayed-release (20 mg, 30 mg, 60 mg) capsules
- generic escitalopram tablets
- generic fluoxetine immediate-release capsules
- generic fluoxetine oral solution
- generic fluvoxamine immediate-release tablets
- generic paroxetine HCl immediate-release tablets
- generic sertraline oral solution
- generic sertraline tablets
- generic venlafaxine extended-release capsules
- generic venlafaxine immediate-release tablets
Initial criteria
- Patient is an adult (age > 18 years)
- Patient has a history of use of one Step 1 Product (Standard Criteria) OR two Step 1 Products (High Impact Criteria) within the 130-day look-back period
Reauthorization criteria
- Same as initial criteria
Approval duration
1 year