Lybalvi — Medical Mutual

Initial criteria

• Patient age ≥ 18 years
• Lybalvi is prescribed by or in consultation with a psychiatrist or a physician who specializes in mental health care
• Patient does not have a known opioid use disorder or is dependent on opioids for a chronic health condition
• Previous trial of generic olanzapine demonstrated positive response, but unacceptable weight gain while on therapy [documentation required] OR Documented trial of two oral, generic second-generation antipsychotics at maximally tolerated doses for at least 4 weeks

Reauthorization criteria

• Response to therapy is required for continuation of therapy

Approval duration

1 year