Relistor — Medical Mutual
Opioid-Induced Constipation (OIC) in adults with chronic non-cancer pain
Initial criteria
- Diagnosis of chronic non-cancer pain OR diagnosis of advanced illness and receiving palliative care
 - Age ≥ 18 years
 - Taking opioids for ≥ 4 weeks
 - Failed on or intolerant to at least 2 of the following within the past 3 months (with or without a stool softener): at least one stimulant laxative (e.g. bisacodyl), OR at least one osmotic laxative (e.g. PEG 3350), OR at least one saline laxative (e.g. magnesium citrate)
 - Not using another opioid antagonist (e.g. naloxone)
 - No known or suspected gastrointestinal obstruction and not at increased risk of recurrent obstruction
 - Failed on or intolerant to BOTH lubiprostone AND Movantik
 
Reauthorization criteria
- Demonstrated a beneficial response to Relistor, per the prescribing physician (e.g. increased number of bowel movements from baseline)
 - Continues to meet all criteria above for initial therapy
 
Approval duration
4 months for patients with advanced illness receiving palliative care; 1 year for patients with chronic non-cancer pain