Gattex

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.  

Questions?

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