CurrentCignaPolicy N/A
Alzheimer's Disease - Namenda/Namenda XR Step Therapy Policy
Defines a step therapy program for memantine products for treatment of moderate to severe Alzheimer's disease, requiring trial of a Step 1 product prior to Step 2 products; approvals are for 1 year. Excludes Namzaric and notes generic memantine ER capsules are not included in either step.
Policy Summary
PayerCigna
PolicyAlzheimer's Disease - Namenda/Namenda XR Step Therapy Policy
Policy CodePolicy N/A
Change TypeClarified / Revised (informational)
Effective Date
Next Review DateNov 12, 2025
Key ActionDocument that the patient has tried one Step 1 product (generic memantine tablets or oral solution); if Step Therapy rule is not met at point of service, coverage will be determined by the Step Therapy criteria and approvals are provided for 1 year.
SourceLink
POLICY UPDATE CHANGES
Policy name updated to begin with 'Alzheimer's Disease' instead of 'Alzheimer's'.
Namenda XR 14, 21, and 28 mg capsules noted as obsolete as of 4/15/2024.
2Step 1 Products
3Step 2 Products
1Excluded Combination Product (Namzaric)
Coverage Summary
Memantine, an NMDA receptor antagonist, is indicated for the treatment of moderate to severe Alzheimer's dementia. The policy defines a step therapy program that encourages use of generic memantine first (Step 1) prior to branded formulations (Step 2).