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Drug - Qutenza (capsaicin 8%) [Acorda Therapeutics]

December 2019

Therapeutic area - Postherpetic neuralgia (PHN)

Approval Criteria

  • Patient has diagnosis of postherpetic neuralgia AND
  • Patient had a documented therapeutic trial and clinical failure or contraindication with all 5 of the following:
    • gabapentin AND
    • pregabalin AND
    • any generic tricyclic antidepressant AND
    • prescription-strength lidocaine patch (requires PA) AND
    • morphine CR

Quantity Limits

  • 4 patches per 90 days

Billing for Qutenza

Qutenza must be billed on a professional claim using J7336 (buy-and-bill).


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

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