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DrugVraylar™ (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


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

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