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 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.
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).
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