Anthem Blue Cross (HMO, PPO, EPO) |
Rexulti (brexpiprazole) |
Drugs for the Nervous System : Drugs for Severe Mental Disorders |
- Prior Authorization: Psychiatry: Schizophrenia:
Documented Diagnosis: Yes
Duration: 1 year(s)
- Major Depressive Disorder:
Duration: 1 year(s)
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Documented Diagnosis: Yes
Psychiatry: Schizophrenia: Duration: 1 year(s)
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Policy Requires Documentation of Patient Noncompliance to Oral Therapy: No
Established tolerability to oral formulation: No
Documented Diagnosis: Yes
- Step Therapy: Psychiatry: Schizophrenia:
ST Multiple Generics
- Quantity Limit: 1 tablet per 1 day(s).
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