Aspirin/omeprazole tablet (generic for Yosprala) — Point32Health

Initial criteria

• Documentation that medication is used for secondary prevention of cardiovascular or cerebrovascular events
• Documentation that the member is at risk of developing aspirin associated gastric ulcers
• Member has tried and failed concurrent therapy with aspirin and omeprazole, or the provider indicates clinical inappropriateness of treatment with the individual ingredients used together
• Documentation of treatment failure or contraindication to two generic PPIs (e.g., esomeprazole, pantoprazole, lansoprazole) in combination with aspirin