UnitedHealthcare
Rexulti (brexpiprazole)
Drugs for the Nervous System : Drugs for Severe Mental Disorders
  • Major Depressive Disorder:
    Duration: 12 Month(s)
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)
    Documented Diagnosis: Yes

    Psychiatry: Schizophrenia:
    Duration: 12 Month(s)
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)
    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: limit maximum 1 EA PER 1 day(s)
  • Prior Authorization: Psychiatry: Schizophrenia:
    Documented Diagnosis: Yes
    Duration: 12 Month(s)
    Reauthorization Required: Yes

<< Return | Back to top