UnitedHealthcare
Relistor (Kit) (methylnaltrexone)
Drugs for Overdose or Poisoning : Drugs for Overdose or Poisoning
  • Opioid Induced Constipation:
    Duration: 6 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)
    Patient must have chronic use of opioids: No
    Patient must not be using methadone: No
    Supporting Documentation Requirements: Chart Notes
    Failed or intolerant to increase in dietary fiber or conventional laxative therapy: Yes

  • Prior Authorization: Opioid Induced Constipation:
    Documented Diagnosis: Yes
    Duration: 6 Month(s)
    Reauthorization Required: Yes

  • Step Therapy: Opioid Induced Constipation:
    ST Generic and Brand

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