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Step therapy program requiring trials of lower-cost/default antidepressants prior to coverage of Auvelity (dextromethorphan/bupropion), Trintellix (vortioxetine), or Fetzima (levomilnacipran) for UnitedHealthcare Commercial Plans. Defines required prior trials, exceptions for inpatient initiation and new-plan members, duration of authorization, and use of claims history for auto-approval.
Added Auvelity to program (3/2023).
Annual reviews and updated references recorded (10/2024, 10/2025).
Requirement to document duration of medication trial in addition to name and date (5/2017).
Added self-look back for auto adjudication (5/2019).
This is a UnitedHealthcare Step Therapy program that requires trials of lower-cost/default antidepressants before covering Auvelity (dextromethorphan/bupropion), Trintellix (vortioxetine), or Fetzima (levomilnacipran) for Commercial plans. The program permits continuation of therapy when members have existing claims history documenting prior use of the requested drug, includes auto-adjudication logic based on claims history and diagnosis codes, and is subject to state mandates and member-specific benefit details.
Authorization - Initial Approval Criteria
Auvelity, Trintellix or Fetzima will be approved based upon ONE of the following:
| No codes listed |
UnitedHealthcare may auto-adjudicate approvals based on claims history, diagnosis codes (ICD-10), and claim logic. The policy explicitly allows automated approval and re-approval processes to vary by program; if a member has three step-one medications in claims history within the previous 180 days, the requested Auvelity, Trintellix, or Fetzima will automatically process. Additionally, members documented in claims as already receiving one of these medications are allowed continuation without meeting step requirements.
Document prior medication trials
Document the drug name, date of the trial, and the duration (at least 4 weeks) for at least three step-one antidepressants from the specified list to support approval. Claims history may be used for auto-approval.
Claims-based auto-adjudication
Payer may automatically approve based on claims history, diagnosis codes (ICD-10), and claim logic. Ensure claims and diagnosis coding accurately reflect prior medication use and dates to support automatic processing.
Exceptions allowed for inpatient initiation
If the requested medication was initiated during a recent inpatient mental health hospitalization and the member is stabilized on the medication, approval can be granted without meeting the three-step trial requirement.
New plan member continuation
New members who are currently stabilized on the requested medication may be approved for continuation when their coverage effective date is less than or equal to 120 days.
Authorization duration
When approved, authorizations are issued for 12 months. Include this duration in billing and authorization records.
Step-one medications: Lower-cost/default antidepressants that must be trialed include bupropion, citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, and venlafaxine IR/ER (capsules).
Added Auvelity to program (3/2023).
Operationalizes requirement to document duration of medication trial in addition to name and date (at least 4 weeks per trial) (5/2017).
Added self-look back for auto adjudication: if three step-one meds present in claims history within 180 days, auto-process (5/2019).
Annual reviews and updated references recorded (10/2024, 10/2025); P&T approval dates updated through 10/2025.