Austedo XR — Medical Mutual

Initial criteria

• The medication is prescribed by or in consultation with a neurologist or psychiatrist
• Patient has an Abnormal Involuntary Movement Scale (AIMS) score of 6 or greater
• Patient is age ≥ 18 years
• Patient has been clinically diagnosed with TD according to the DSM V Criteria: Involuntary athetoid or choreiform movements; AND History of treatment with a neuroleptic agent (i.e. antipsychotic); AND Symptoms lasting longer than 4-8 weeks

Reauthorization criteria

• Clinical response to therapy is required for continuation

Approval duration

1 year