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Abilify MyCite (aripiprazole tablet with sensor) — United Healthcare

autistic disorder

Preferred products

  • Abilify Maintena
  • Risperdal Consta
  • Invega Trinza

Initial criteria

  • Diagnosis of schizophrenia OR bipolar I disorder OR major depressive disorder OR autistic disorder OR Tourette’s disorder
  • Submission of medical records documenting the patient is currently prescribed aripiprazole and tolerates the medication
  • Submission of medical records documenting the patient’s adherence to aripiprazole is less than 80% within the past 6 months
  • All of the following strategies to improve patient adherence have been tried without success: (1) Utilization of a pill box AND (2) Utilization of a smart phone reminder (e.g. alarm, application, or text reminder) AND (3) Involving family members or friends to assist AND (4) Coordinating timing of dose to coincide with dosing of another daily medication
  • Submission of medical records documenting patient has experienced life-threatening or potentially life-threatening symptoms, or has experienced a severe worsening of symptoms leading to hospitalization which was attributed to the lack of adherence to aripiprazole
  • History of failure, contraindication, or intolerance to one long-acting injectable antipsychotic (e.g. Abilify Maintena, Risperdal Consta, Invega Trinza)
  • Prescriber acknowledges that Abilify MyCite has not been shown to improve patient adherence and attests that Abilify MyCite is medically necessary for the patient to maintain compliance, avoid life-threatening worsening of symptoms, and reduce healthcare resources utilized due to lack of adherence
  • Prescriber agrees to track and document adherence of Abilify MyCite through software provided by the manufacturer

Reauthorization criteria

  • Documentation that patient is clinically stable on Abilify MyCite
  • Submission of medical records documenting that the use of Abilify MyCite has increased adherence to 80% or more
  • Prescriber attests that the patient requires the continued use of Abilify MyCite to remain adherent

Approval duration

12 months