Trintellix — Point32Health
Obsessive-compulsive disorder (OCD)
Preferred products
- Citalopram HBr
- Escitalopram Oxalate
- Fluoxetine HCL
- Fluvoxamine Maleate
- Paroxetine HCL
- Paroxetine Mesylate Capsules
- Sertraline HCL
- Desvenlafaxine Succinate ER Tablets
- Desvenlafaxine ER 24hr Tablets
- Duloxetine HCL Capsules
- Venlafaxine HCL Tablets
- Bupropion HCL
Initial criteria
- Patient has had a trial of ONE (1) Step-1 or the requested Step-2 medication as evidenced by a previous paid claim under the prescription benefit administered by the plan
- OR Patient has had a trial of a Step-1 or the requested Step-2 medication as evidenced by physician’s documented use, excluding the use of samples
- OR Patient has a physician documented trial and failure with one, or contraindication or intolerance to all of the Step-1 medications
- OR Patient was recently started on the requested medication in an acute care setting, residential setting, or partial hospital setting
- OR Patient lives in or the prescribing provider's office is located in Maine