Parkinson's Disease - Nuplazid Prior Authorization Policy
This policy governs prior authorization and coverage criteria for Nuplazid (pimavanserin) for treatment of hallucinations and delusions associated with Parkinson's disease psychosis for Cigna-administered health benefit plans.
No material clinical or coverage changes in this revision.
Coverage Criteria for Nuplazid (pimavanserin)
FDA-Approved Indication (Parkinson's Disease Psychosis)
Covered when ALL of the following are met
Parkinson's Disease Psychosis coverage criteria
- Patient has hallucinations and delusions associated with Parkinson's disease psychosis.
- Patient does not have dementia-related psychosis unrelated to the hallucinations and delusions associated with Parkinson's disease psychosis.
- Medication is prescribed by or in consultation with a neurologist.
Use of Nuplazid (pimavanserin) for dementia-related psychosis that is unrelated to the hallucinations and delusions associated with Parkinson’s disease psychosis is considered experimental/investigational and is not covered.
Nuplazid carries a Boxed Warning for increased mortality in elderly patients with dementia-related psychosis; such uses are not approved and may be denied.
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