Nuplazid — Medical Mutual

Initial criteria

• Patient age ≥ 18 years; AND
• Diagnosis of Parkinson’s disease for ≥ 1 year; AND
• Hallucinations and/or delusions associated with Parkinson’s disease psychosis for ≥ 1 month; AND
• No dementia-related psychosis unrelated to the hallucinations/delusions of PDP; AND
• Tried or has a contraindication to quetiapine or clozapine; AND
• Prescribed by or in consultation with a neurologist; AND
• No history of cardiac arrhythmias or QT prolongation; AND
• Will not use concomitantly with medications that prolong QT interval; AND
• Will not use concomitantly with other antipsychotic medications (except during switching)

Reauthorization criteria

• Patient age ≥ 18 years; AND
• Experienced improvement in frequency or severity of hallucinations and/or delusions associated with Parkinson’s disease psychosis; AND
• Prescribed by or in consultation with a neurologist

Approval duration

365 days initial, 365 days reauth