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DrugMovantik™ (naloxegol oxalate tablets) [AstraZeneca]

March 2018

Therapeutic area - Opioid induced constipation

Approval criteria

  • Patient is at least 18 years of age 
  • Patient is diagnosed with opioid-induced constipation (OIC) related to chronic non-cancer pain AND
  • Patient is currently on opioids 
  • Patient has been using opioids for at least 75 days within the past 90 days AND
  • Patient has not tolerated or has had inadequate response to one-month trials of a stimulant laxative (e.g., bisacodyl; sennosides) AND polyethylene glycol 3350 OR other osmotic laxative (e.g., sorbitol, lactulose, magnesium citrate, magnesium hydroxide, glycerin rectal suppositories) as documented in pharmacy fill history or other documentation indicating fill/refill history if patient is new to Medical Assistance and pharmacy claims data is not readily available AND
  • Patient has not tolerated or has had inadequate response to a one-month trial of Amitiza OR
  • Patient’s OIC is due to diphenylheptane opioids (e.g., methadone) AND
  • Patient does not have ANY of the following conditions:
    • Known or suspected gastrointestinal obstruction OR
    • Pregnancy OR
    • Severe hepatic impairment (Child-Pugh Class C)

Quantity limit

Maximum one tablet daily (34 tablets per 34 days)


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

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