Amrix

Drug - Amrix (extended release cyclobenzaprine) capsules 15mg, 30mg - Generic cyclobenzaprine extended release, 15 mg, 30 mg.

May 2011

Therapeutic area - Muscle Relaxant

Criteria

• 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

Quantity limit

Applies to both 15 mg and 30 mg:

• Quantity limit of 21 

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

Cost differential

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). 

Dosing

Once daily - 15 mg up to 30 mg. 

Questions?

MHCP Provider Call Center 651-431-2700 or 800-366-5411