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The Policy VaultThe Policy Vault

All antidepressants other than those specifically listed as covered for pediatricsPoint32Health

Depression or other behavioral health conditions in pediatrics 12 years of age and younger

Preferred products

  • fluoxetine
  • venlafaxine
  • fluvoxamine
  • citalopram
  • escitalopram
  • clomipramine
  • sertraline
  • imipramine
  • duloxetine
  • Fluoxetine-olanzapine

Initial criteria

  • Documentation that patient had a recent psychiatric hospitalization
  • OR Documentation that patient has a history of severe risk of harm to self or others
  • OR Documentation that patient is stable on the requested antidepressant for more than 2 months
  • OR Documentation that the patient has tried and failed at least 1 preferred agent (listed on the table above), as appropriate for the patient’s diagnosis AND the requested antidepressant is prescribed by a specialist or in consultation with a specialist (psychiatrist, neurologist, or developmental pediatrician)