Debonnel G; Saint-Andre E; Hebert C; et al. Differential Physiological Effects of a Low Dose and High Doses of Venlafaxine in Major Depression. Int J Neuropsychopharmacol. 2007 Feb; 10(1):51-61 Approved Indications: Hospital Discharge: Concomitant Treatment Refractory 60 days Antipsychotic 1. Schizophrenia spectrum disorders or Treatment 2. Bipolar disorder, with psychosis and/or severe symptoms Initial Approval: 60 days for cross taper Special Considerations: Cross tapers will automatically be approved for 60 days. Providers must submit a prior 6 months for authorization request for continued utilization of concomitant use of any 2 antipsychotics taper beyond the 60 days allowed for cross tapering. Guidelines for Approval for refractory schizophrenia spectrum disorder: Renewal: 1. Evidence of adequate trials of at trial three (3) individual formulary antipsychotics, one of which is 1 year clozapine, 4-6 weeks of maximum tolerated doses, and failure due to: a. Inadequate response to maximum tolerated dose b. Adverse reaction(s), c. Break through symptoms Guidelines for Approval for refractory bipolar disorder with psychosis and/or severe symptoms: 1. Evidence of adequate trials of at least four (4) evidence based treatment options dependent upon the episode type. Trials may include lithium, divalproex, atypical antipsychotic monotherapy, carbamazepine, haloperidol, lamotrigine, lithium + an anticonvulsant, lithium + an antipsychotic, or an anticonvulsant + an antipsychotic. Trials should be 4-6 weeks of maximum tolerated doses, with failure due to: a. Inadequate response to maximum tolerated dose b. Adverse reaction(s), c. Break through symptoms Additional Requirements:
Debonnel G; Saint-Andre E; Hebert C; et al. Differential Physiological Effects of a Low Dose and High Doses of Venlafaxine in Major Depression. Int J Neuropsychopharmacol. 2007 Feb; 10(1):51-61 Concomitant Antipsychotic Treatment Approved Indications: Treatment Refractory 1. Schizophrenia spectrum disorders or 2. Bipolar disorder, with psychosis and/or severe symptoms Special Considerations: Cross tapers will automatically be approved for 60 days. Providers must submit a prior authorization request for continued utilization of concomitant use of any 2 antipsychotics beyond the 60 days allowed for cross tapering. Guidelines for Approval for refractory schizophrenia spectrum disorder: 1. Evidence of adequate trials of at three (3) individual formulary antipsychotics, one of which is clozapine, 4-6 weeks of maximum tolerated doses, and failure due to: a. Inadequate response to maximum tolerated dose b. Adverse reaction(s), c. Break through symptoms Guidelines for Approval for refractory bipolar disorder with psychosis and/or severe symptoms: 1. Evidence of adequate trials of at least four (4) evidence based treatment options dependent upon the episode type. Trials may include lithium, divalproex, atypical antipsychotic monotherapy, carbamazepine, haloperidol, lamotrigine, lithium + an anticonvulsant, lithium + an antipsychotic, or an anticonvulsant + an antipsychotic. Trials should be 4-6 weeks of maximum tolerated doses, with failure due to: a. Inadequate response to maximum tolerated dose b. Adverse reaction(s), c. Break through symptoms Additional Requirements: Hospital Discharge: 60 days Initial Approval: 60 days for cross taper 6 months for taper Renewal: 1 year trial
Mercy-Maricopa-Integrated-Care-PA-Guidelines-SMI.docx