Some insurance providers and Medicare Part D plans may require prior authorization (PA) for the patients or residents for whom you prescribe NUEDEXTA. Each health plan will determine the PA criteria for its formulary. There are 4 common pieces of documentation generally requested by plans as part of their PA process to ensure that NUEDEXTA is being used safely and appropriately.
- Documentation of primary diagnosis
- Documentation of underlying conditions
- Documentation that NUEDEXTA is not contraindicated for the patient (please refer to the Prescribing Information)
- Documentation of medical or clinical history
- For reauthorization: Usually at the start of the year, documentation of symptom improvement and/or improvement to the CNS-LS scores may be required
CNS-LS=Center for Neurologic Study-Lability Scale; ICD-10-CM=International Classification of Diseases, Tenth Revision, Clinical Modification; PBA=pseudobulbar affect.
NUEDEXTA Connect partners with CoverMyMeds® to streamline prior authorizations for providers and pharmacists, and works to provide many other patient support services that remove access barriers to therapy.†
Prior authorization and formulary exception support
- Reimbursement Managers
- Referrals to independent foundations
†Restrictions apply. Most commercially insured patients pay as little as $0 for a 90-day supply or $20 for a 30-day supply. Patients who are eligible for any state or federally funded prescription programs, including Medicare, Medicaid, Medigap, VA, DOD, or TriCare, are not eligible for this program.
Call 1-855-4NUEDEX (1-855-468-3339) Monday through Friday | 8 AM to 8 PM ET
Create a free account or log in to your existing account at CoverMyMeds.com. You can start a NUEDEXTA Connect enrollment or seamlessly submit, track, and manage prior authorization requests.
For additional support, call Otsuka Connect at 1-833-468-7852, Monday through Friday, 8 AM to 8 PM eastern time, excluding holidays.