Caplyta (lumateperone) — United Healthcare
depressive episodes associated with bipolar I or II disorder (bipolar depression)
Preferred products
- aripiprazole
- olanzapine
- quetiapine IR or ER
- risperidone
- ziprasidone
- olanzapine in combination with an SSRI (e.g., fluoxetine)
Initial criteria
- Diagnosis of schizophrenia AND history of failure, contraindication, or intolerance to three of the following (document drug, date and duration of trial): aripiprazole (generic Abilify), olanzapine (generic Zyprexa), quetiapine IR or ER (generic Seroquel or Seroquel XR), risperidone (generic Risperdal), ziprasidone (generic Geodon)
- OR Diagnosis of depressive episodes associated with bipolar I or II disorder (bipolar depression) AND history of failure, contraindication, or intolerance to both of the following (document date and duration of trial): olanzapine (generic Zyprexa) in combination with an SSRI (e.g., fluoxetine), quetiapine IR or ER (generic Seroquel or Seroquel XR)
- OR Treatment with Caplyta was initiated at a recent behavioral inpatient admission (discharge within the past 3 months) and member is currently stable on therapy (document date of discharge)
- OR Member is new to the plan and currently stabilized on Caplyta (coverage effective date ≤ 120 days)
Reauthorization criteria
- Documentation of a positive clinical response to therapy
Approval duration
12 months