CurrentColorado Rocky Mountain Health PlansPolicy N/A

Step therapy for select antidepressants (Auvelity, Trintellix, Fetzima)

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Defines step therapy requirements for coverage of Auvelity (dextromethorphan/bupropion), Trintellix (vortioxetine), and Fetzima (levomilnacipran) for members covered under UnitedHealthcare Pharmacy Clinical Pharmacy Programs; affects new therapy starts and members changing plans.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyStep therapy for select antidepressants (Auvelity, Trintellix, Fetzima)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateDec 1, 2025

Last ReviewOct 25, 2025

Next Review DateOct 1, 2025

Key ActionObtain and document trials of at least three listed step-one medications (name, date, duration ≥4 weeks) or confirm three step-one fills in claims history for automated approval.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3required step-one medication trials

180look-back period (days)

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CurrentColorado Rocky Mountain Health PlansPolicy N/A

Step therapy for select antidepressants (Auvelity, Trintellix, Fetzima)

Customize your policy alerts

Sign up for all Colorado Rocky Mountain Health Plans policy alerts

Know when Colorado Rocky Mountain Health Plans releases new policies or updates existing guidance.

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Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyStep therapy for select antidepressants (Auvelity, Trintellix, Fetzima)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateDec 1, 2025

Last ReviewOct 25, 2025

Next Review DateOct 1, 2025

Key ActionObtain and document trials of at least three listed step-one medications (name, date, duration ≥4 weeks) or confirm three step-one fills in claims history for automated approval.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3required step-one medication trials

180look-back period (days)

Coverage Criteria

inv-01: Initial Therapy

Covered when ANY of the following criteria are met:

Initial approval pathways: 1) History of failure after at least 4 weeks of therapy, contraindication, or intolerance to at least THREE of the specified step-one medications (document drug and date of trials); OR 2) Requested medication was initiated during a recent inpatient mental health hospitalization and the member is stabilized on the requested medication; OR 3) Member is new to the plan and currently stabilized on the requested medication (evidenced by coverage effective date ≤ 120 days).see node text

Trials should be documented; automated approval available if claims show three step-one meds in prior 180 days.

inv-02: Continuation / Reauthorization

Authorization and continuation rules

Authorization duration: Authorization will be issued for 12 months.12 months

State mandates, federal requirements, and the member-specific benefit plan may impact coverage.

Continuation of therapy: Members with historical claims showing Auvelity, Trintellix, or Fetzima will be allowed continued coverage of their current therapy; UnitedHealthcare may also approve initial and reauthorization based solely on previous claim/medication history, diagnosis codes, and/or claim logic.coverage documented in claims or claim logic

Supply limits may apply; automated processes vary by program.

None explicitly stated in this document.

Use of Auvelity (dextromethorphan/bupropion), Trintellix (vortioxetine), or Fetzima (levomilnacipran) without documentation that the member has experienced failure, contraindication, or intolerance to at least three specified first-line agents may be considered not meeting step therapy requirements. The policy requires documentation of the drug and date for each trial and specifies a minimum trial duration of 4 weeks for establishing failure/intolerance; automated approval is possible if claims show three step-one medications within the prior 180 days.

Initial Therapy

inv-12: Initial Therapy

Initial therapy coverage conditions

Initial approval: Approval based on ONE of the following: (a) History of failure after ≥4 weeks of therapy, contraindication, or intolerance to at least THREE of the listed step-one medications (document drug name and date of each trial); OR (b) Medication was started during a recent inpatient mental health hospitalization and the member is stabilized on it; OR (c) Member is new to the plan and currently stabilized on the requested medication (coverage effective date ≤ 120 days).≥3 drugs, ≥4 weeks each or coverage effective date ≤ 120 days

Document drug name and date of trials; claims history may be used for automated approval if three step-one medications appear within the prior 180 days.

Continuation Therapy

inv-13: Continuation Therapy

Continuation allowed when member is already stabilized or has prior claim history

Continuation: Members with historical claims for Auvelity, Trintellix, or Fetzima will be allowed continued coverage of their current therapy; members new to the plan who are currently stabilized (coverage effective date ≤ 120 days) are eligible for continuation.coverage in claims or effective date ≤ 120 days

UnitedHealthcare may approve based on prior claim/medication history, diagnosis codes, and/or claim logic; supply limits may apply.

Step Therapy Requirements

Medication name	Date of trial	Duration of trial
1. bupropion
[enter date of trial]
[enter duration in weeks; minimum 4 weeks required]
2. citalopram
[enter date of trial]
[enter duration in weeks; minimum 4 weeks required]
3. duloxetine
[enter date of trial]
[enter duration in weeks; minimum 4 weeks required]

Claims Look-back and Continuity Thresholds

Claims look-back / continuity thresholds

Claims look-back for automated approvalThree step-one medications appearing in the member's claims history within the previous 180 days will allow Auvelity, Trintellix, or Fetzima to automatically process.

New-to-plan continuation windowMembers new to the plan who are currently stabilized on the requested medication are eligible for continuation when the coverage effective date is less than or equal to 120 days.

Continuation based on prior claimsMembers with historical claims documenting Auvelity, Trintellix, or Fetzima will be allowed continued coverage of their current therapy.

Provider Actions and Documentation

Prior Authorization

Prior Authorization Required

Prior authorization is required for Auvelity, Trintellix, and Fetzima unless the member has three step‑one medications in claims history within the previous 180 days. Members with documented prior use of Auvelity, Trintellix, or Fetzima in claims history will be allowed continued coverage of their current therapy. Members new to therapy must meet the step therapy criteria below.

Applies to: Auvelity, Trintellix, Fetzima
Auto‑adjudication: If claims history shows ≥3 step‑one medications within prior 180 days, prior authorization is not required

Step Therapy

Step Therapy Requirement

Member must have trialed at least three step‑one antidepressant medications (any formulation) with documentation of drug name and date of trial. Each trial must be a minimum of 4 weeks unless there is documented intolerance or contraindication. If the member has documented failure, contraindication, or intolerance to at least three of the listed agents, coverage for Auvelity, Trintellix, or Fetzima will be approved.

Definitions

Step-one medications

BupropionListed as a required step-one antidepressant formulation for step therapy trials.

CitalopramListed as a required step-one antidepressant formulation for step therapy trials.

DuloxetineListed as a required step-one antidepressant formulation for step therapy trials.

EscitalopramListed as a required step-one antidepressant formulation for step therapy trials.

FluoxetineListed as a required step-one antidepressant formulation for step therapy trials.

FluvoxamineListed as a required step-one antidepressant formulation for step therapy trials.

Paroxetine

Background

Step therapy programs are designed to encourage use of lower-cost, established alternatives before covering newer or higher-cost agents. This policy applies that sequencing logic to these three antidepressants by requiring a trial of at least three step-one medications (from the listed first-line agents) prior to approval, with an automated processing pathway when claims history documents those three agents within the prior 180 days and allowance for continued coverage when the member is already stabilized on the requested medication.