Vraylar

Drug - Vraylar™ (cariprazine) [Allergan]

January 2017

Therapeutic area - Mental Health

Approval criteria

• Patient has been stabilized on Vraylar (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 Vraylar 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 schizophrenia OR bipolar I disorder AND
• Patient must not have dementia-related psychosis AND
• Patient must have tried and failed oral aripiprazole AND one other preferred oral atypical antipsychotic (e.g., olanzapine, quetiapine, risperidone, etc.)

Quantity limit

• Capsules (1.5 mg, 3 mg, 4.5 mg, 6 mg): 34 capsules per 34 days
• Starter Pack (One 1.5 mg capsule and six 3 mg capsules): 7 capsules

Questions?

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