Drug - Amrix (extended release cyclobenzaprine) capsules 15mg, 30mg - Generic cyclobenzaprine extended release, 15 mg, 30 mg.
Therapeutic area - Muscle Relaxant
- There is submitted clinical documentation of inability to take other generically available forms of cyclobenzaprine hydrochloride AND
- This drug is prescribed for only short term (2 to 3 weeks of use) AND
- Patient has shown an efficacy response to immediate release cyclobenzaprine AND
- Patient is undergoing physical therapy AND
- Prescriber is made aware of the quantity limit AND
- The prescriber is made aware of the price differential and that the recipient will have to pay a $3 co-pay rather than a $1 co-pay AND
- Grandfathering criteria does not apply
Applies to both 15 mg and 30 mg:
FDA approved indication
Indicated as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions. Should be used only for up to 2-3 weeks
Amrix, an extended release preparation of cyclobenzaprine, is about $9 to $18 per day more expensive than immediate release cyclobenzaprine (5 mg, 7.5 mg and 10 mg).
Once daily - 15 mg up to 30 mg.
MHCP Provider Call Center 651-431-2700 or 800-366-5411