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Drug - Gattex [NPS Pharmaceuticals]

June 2013

Therapeutic area - Gastrointestinal

Approval criteria

  • Patient has a diagnosis of short bowel syndrome AND
  • Patient has been on parenteral nutritional support for 1 year and is currently on parenteral nutrition support AND
  • Patient has a documented high risk of infection or hospitalization related to parenteral nutritional support

Initial authorizations are approved for 6 months.

Reauthorization criteria

Provider must provide medical documentation showing a clinically significant reduction in parenteral nutrition volume since starting therapy has been achieved.

Quantity limit

  • Kit = 1 (30 vials)
  • Single use vials = 34

Gattex comes as a single-use vial kit and a kit containing 30 single-use vials. The recommended dose is 0.05 mg/kg/day.  


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

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