Northera (droxidopa) — United Healthcare
symptomatic neurogenic orthostatic hypotension (nOH)
Preferred products
- fludrocortisone
- midodrine
Initial criteria
- Diagnosis of symptomatic neurogenic orthostatic hypotension (nOH) defined by ≥20 mm Hg fall in systolic pressure OR ≥10 mm Hg fall in diastolic pressure when upright position assumed or by head-up tilt-table testing at angle ≥60 degrees
- nOH caused by one of the following: primary autonomic failure (Parkinson’s disease, multiple system atrophy, pure autonomic failure) OR dopamine beta-hydroxylase deficiency OR non-diabetic autonomic neuropathy
- Diagnostic evaluation excludes other causes associated with orthostatic hypotension (e.g., congestive heart failure, fluid restriction, malignancy)
- Tried at least two of the following non-pharmacologic interventions: discontinuation of drugs causing orthostatic hypotension; raising head of bed 10–20 degrees; compression garments to lower extremities or abdomen; physical maneuvers to improve venous return (e.g., modest exercise); increased salt and water intake if appropriate; avoiding precipitating factors (e.g., overexertion in heat, rapid position changes)
- No previous diagnosis of supine hypertension
- Prescribed by or in consultation with a cardiologist, neurologist, or nephrologist
- History of failure after at least 30‑day trial, contraindication, or intolerance to both fludrocortisone and midodrine
Reauthorization criteria
- Documentation of positive clinical response to Northera therapy
- Physiological countermeasures for nOH continue to be employed
Approval duration
12 months