Anthem Blue Cross (HMO, PPO, EPO)
Movantik (naloxegol)
Drugs for Overdose or Poisoning : Drugs for Overdose or Poisoning
  • Step Therapy: Opioid Induced Constipation:
    ST Multiple Generics

  • Quantity Limit: 1 tablet per 1 day(s).
  • Opioid Induced Constipation:
    Duration: 1 year(s)
    Documented Diagnosis: No
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Patient must have chronic use of opioids: No
    Patient must not be using methadone: No
    Failed or intolerant to increase in dietary fiber or conventional laxative therapy: Yes

  • Prior Authorization: Opioid Induced Constipation:
    Duration: 1 year(s)

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