Gattex — Medical Mutual
Short Bowel Syndrome, Patient is Currently Receiving Gattex
Reauthorization criteria
- Patient has already received at least 6 months of therapy with Gattex; AND
- According to the prescriber, patient has experienced at least a 20% decrease from baseline in the weekly volume of parenteral nutrition; AND
- Agent is prescribed by or in consultation with a gastroenterologist; AND
- Bilirubin, alkaline phosphatase, lipase, and amylase lab values have been assessed within the past 6 months; AND
- Patient has no contraindications to Gattex
Approval duration
365 days