HumanaCommercial Clinical Policy

Rexulti (brexpiprazole) Form

Chat with GenHealth to automate any policy or prior auth task.


Rexulti (brexpiprazole) for Major Depressive Disorder

Notes: Experimental/Investigational Use: Indications not supported by CMS recognized compendia or acceptable peer-reviewed literature are not covered.

Indications

(461096) Has the patient been clinically diagnosed with major depressive disorder? 
(461097) Is there documentation of prior therapy, intolerance, or contraindication to aripiprazole AND at least one antidepressant therapy (e.g., citalopram, fluoxetine)? 
(461098) Will Rexulti be used as adjunctive treatment to an antidepressant therapy (ADT) and not as monotherapy? 

Contraindications

(461099) Does the patient, being 65 years of age or older, have dementia-related psychosis without an approvable diagnosis? 

Rexulti (brexpiprazole) for Schizophrenia

Notes: Experimental/Investigational Use: Indications not supported by CMS recognized compendia or acceptable peer-reviewed literature are not covered.

Indications

(461100) Has the patient been clinically diagnosed with schizophrenia? 

YesNoN/A
YesNoN/A

Sign up to see the rest of the questions

Unlock the remaining questions and the full coverage workflow.

Sign up for free
Effective Date

01/01/2020

Last Reviewed

05/25/2022

Original Document

  Reference



.

J

Book a walkthrough

Walk through this policy with us

Review how this policy can be converted into cited criteria, prior authorization checks, and operational automation.