CurrentColorado Rocky Mountain Health PlansPolicy N/A

Step therapy requirement for Azilect (rasagiline)

Defines UnitedHealthcare's step therapy requirement that members must try generic selegiline before coverage for brand Azilect (rasagiline) is approved; applies to members under the Essential PDL referenced by the program.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyStep therapy requirement for Azilect (rasagiline)

Policy CodePolicy N/A

Change TypeAdministrative / non‑material

Effective Date6/1/2025

Next Review DateN/A

Key ActionObtain prior authorization and document failure, contraindication, or intolerance to selegiline when requesting coverage for Azilect.

SourceLink

POLICY UPDATE CHANGES

3/2025 entry shows 'No changes' for the Step Therapy - Azilect program

Program clarified to apply to Essential PDL only (administrative change noted 1/2017)

2025-06-01policy effective date

selegilinerequired step (generic)

12 moauthorization duration

2016-2025policy review history

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Initial Authorization

Covered when ALL of the following are met:

Initial authorization criteria: 1) Documented history of failure, contraindication, or intolerance to selegiline (generic Eldepryl) with the reason for failure/contraindication/intolerance listed. 2) Prior authorization requested and approved; authorization will be issued for 12 months.

Member-specific benefit plan, state mandates, and federal regulatory requirements may affect coverage.

Coverage for Azilect (rasagiline) is subject to state mandates, federal regulatory requirements, and the member's specific benefit plan. These external requirements may restrict or modify coverage determinations and take precedence where applicable. In addition, other policies and utilization management programs may apply and affect authorization decisions.

Provider Actions & Requirements

Prior Authorization

Prior Authorization Required

Prior authorization required. Approval will be issued for 12 months. State mandates, federal regulatory requirements, and the member-specific benefit plan may affect coverage; other policies and utilization management programs may also apply.

Step Therapy

Step Therapy Requirement

Step therapy requirement — member must trial the lower-cost generic selegiline (Eldepryl) prior to coverage of brand Azilect (rasagiline). Document the reason for therapeutic failure, contraindication, or intolerance to the required alternative when requesting coverage.

Required alternative: selegiline (generic Eldepryl)

Documentation Required

Required Documentation

Provider must document the reason for therapeutic failure, contraindication, or intolerance to selegiline when requesting coverage of Azilect. The documentation should explicitly state the clinical rationale for why the lower-cost alternative is not appropriate for the member.

Documented reason for failure, contraindication, or intolerance to selegiline must be included with the prior authorization request

Denial Risk

Coverage for brand Azilect will be denied unless there is a documented history of failure, contraindication, or intolerance to the required lower-cost alternative (selegiline).

Initial Therapy Requirement

Initial therapy requirement

Initial coverage condition:

Initial therapy: Approval of Azilect requires documented failure, contraindication, or intolerance to selegiline (generic Eldepryl).

Provider must list the reason for therapeutic failure, contraindication, or intolerance.

Step	Required prior therapy	Notes
1	Trial of generic selegiline (generic Eldepryl)	Approval of Azilect (rasagiline) requires documented history of failure, contraindication, or intolerance to selegiline; provider must list reason for therapeutic failure, contraindication, or intolerance. Prior authorization is required and, if approved, will be issued for 12 months.

Definitions

Therapeutic failure/contraindication/intolerance — definition

DefinitionClinical or tolerability reasons documented by the provider that justify not using or discontinuing the required lower‑cost alternative (selegiline).

Required supporting detailProvider must list the specific reason for therapeutic failure, contraindication, or intolerance when requesting coverage for Azilect.

Required prior agentSelegiline (generic Eldepryl) is the lower‑cost alternative that must be tried before Azilect (rasagiline) is approved.

Documentation expectationHistory of failure, contraindication, or intolerance to selegiline must be documented in the request.

ContextThis definition supports the Step Therapy program which requires trial of the generic before coverage of brand Azilect.

Background

Step therapy programs are used to encourage use of lower-cost alternatives within therapeutic classes. This program requires a trial of the lower-cost generic selegiline (Eldepryl) prior to approval of brand Azilect (rasagiline).

Prior authorization is required for Azilect and, when approved, will be issued for 12 months. Providers must document the clinical reason for therapeutic failure, contraindication, or intolerance to selegiline when requesting coverage; lack of this documentation is a basis for denial.