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Drug - Aristada™ (aripiprazole lauroxil) [Alkermes]

January 2018

Therapeutic area - Mental Health

Approval criteria

  • Patient has a diagnosis of schizophrenia AND
  • Patient is 18 years of age or older AND
  • Patient has shown a favorable response to oral aripiprazole (Abilify) in efficacy measures AND
  • Provider provides documentation of a three-month trial and failure of Abilify Maintena
  • Patient has demonstrated poor compliance (> 30% missed doses) with oral aripriprazole (Abilify) OR
  • Patient has been stabilized on Aristada (the drug is part of the patient’s current course of treatment) as covered on a previous health insurance plan, and patient is new to Medical Assistance OR
  • Patient was started and stabilized on Aristada in an acute care setting, such as during a hospitalization, or within another place of care that offers acute care services


Aristada is not covered through the MHCP fee-for-service pharmacy benefit and must be submitted as a medical claim.


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

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