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The Policy VaultThe Policy Vault

Xenazine — Medica

any indication meeting standard Vesicular Monoamine Transporter Type 2 Inhibitors Prior Authorization Policy criteria

Preferred products

  • generic tetrabenazine tablets

Initial criteria

  • Patient meets the standard Vesicular Monoamine Transporter Type 2 Inhibitors Prior Authorization Policy criteria
  • Patient has tried the Preferred Product (generic tetrabenazine tablets) OR meets exception criteria

Reauthorization criteria

  • Patient continues to meet standard Vesicular Monoamine Transporter Type 2 Inhibitors Prior Authorization Policy criteria

Approval duration

1 year