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Drug - Rexulti™ (brexpipraxole) [Otsuka American Pharmaceutical, Inc.]

November 2015

Therapeutic area - Atypical Antipsychotics

Approval criteria – Schizophrenia

The patient must meet criteria as follows:

  • Has been stabilized on Rexulti (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 (MA) OR
  • Was started and stabilized on Rexulti in an acute care setting, such as during a hospitalization or within another place of care that offers acute care services OR
  • Is 18 years of age or older and has a diagnosis of schizophrenia and has failed to respond to, or experiences intolerable side effects to adequate trials of risperidone and aripiprazole

Approval criteria – Major depressive disorder

The patient must meet all of the following criteria:

  • Is 18 years of age or older 
  • Has a diagnosis of major depressive disorder 
  • Has tried and failed two separate two-month trials of two preferred SSRIs (see table below)
  • Has a documented intolerance or contraindication to or has tried and failed a two-month trial of one other preferred new generation antidepressant (i.e. venlafaxine, bupropion, mirtazapine or a tri-cyclic antidepressant) (see table below)
  • Will be taking another antidepressant concurrently with Rexulti

Selective Serotonin Reuptake Inhibitors (SSRI)

Preferred Nonpreferred
fluoxetine Lexapro
Paxil/Paxil CR
paroxetine Prozac
Pexeva Fluoxetine DR (weekly)
Prozac Weekly
sertraline paroxetine suspension
Viibryd (individual PA criteria apply)

New Generation Antidepressants

Preferred Nonpreferred
bupropion IR, SA, XL Aplenzin* (bupropion HBr)
fluvoxamine Cymbalta
mirtazapine Desyrel
nefazodone Effexor, Effexor XR
trazodone Luvox CR*
venlafaxine extended release Pristiq*
venlafaxine extend release capsules (generic Effexor XR) Remeron
venlafaxine extended release tablets (generic) Wellbutrin/ SR / XL
* individual PA criteria apply

Quantity limits

Quantity Limit = 34 (All strengths)

Dosing for major depressive disorder will be limited to 3 mg once daily; dosing for schizophrenia will be limited to 4 mg once daily.


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

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