Health Net
Motegrity (prucalopride)
Drugs for the Stomach : Drugs for the Stomach
  • Chronic Idiopathic Constipation:
    Age Requirement: >= 18
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)
    Patient does not have known or suspected mechanical obstruction: No
    Diagnosis of severe CIC: No
    Duration Required for Patient to Have Symtoms of CIC: N/A
    Patient has known or suspected mechanical obstruction: No
    Symptoms > 3 months: No
    Failure of 1 conventional laxative therapy: No
    Failure of 2 conventional laxative therapies: No
    Failure of 3 conventional laxative therapies: Yes

  • Step Therapy: Chronic Idiopathic Constipation:
    Step Applies
  • Prior Authorization: Chronic Idiopathic Constipation:
    PA Applies