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Drug Nuplazid™ (pimavanserin) [Acadia Pharmaceuticals, Inc.]

January 2017

Therapeutic area - Mental Health

Approval criteria

  • Patient has been stabilized on Nuplazid (the drug is part of the recipient'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 Nuplazid in an acute care setting, such as during a hospitalization or within another place of care that offers acute care services OR
  • Patient is 18 years of age or older AND
  • Patient has a diagnosis of Parkinson’s disease psychosis AND
  • Diagnosis of psychosis was made AFTER the Parkinson’s disease was established AND
  • Patient must not have one of these conditions:
    • Dementia-related psychosis
    • Hepatic impairment
    • Severe renal impairment
    • History of cardiac arrhythmias

Quantity limits

68 tablets per 34 days


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

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