CurrentColorado Rocky Mountain Health PlansPolicy N/A

Step therapy for extended-release carbidopa/levodopa (Crexont, Rytary)

This program governs prior authorization and step therapy requirements for Crexont (carbidopa/levodopa ER) and Rytary for members of Colorado Rocky Mountain Health Plans; it affects prescribers and pharmacy benefit adjudication for adult Parkinson's disease indications.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyStep therapy for extended-release carbidopa/levodopa (Crexont, Rytary)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJun 1, 2026

Next Review DateMar 1, 2026

Key ActionRequire documented trial and suboptimal response, contraindication, or intolerance to immediate‑release carbidopa/levodopa (generic Sinemet) or listed alternatives before approving Crexont or Rytary.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Step Therapyprogram type

12 monthsauthorization duration

Crexont, Rytarymedications

Immediate‑releaserequired prior agent

Coverage Criteria

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Initial Authorization Criteria

Covered when ALL of the following are met

Step therapy requirement: History of suboptimal response, contraindication, or intolerance to ONE of: (a) carbidopa/levodopa immediate-release (generic Sinemet), (b) carbidopa/levodopa controlled-release (generic Sinemet CR), or (c) carbidopa/levodopa/entacapone (generic Stalevo)

Approval duration: 12 months

Rytary (brand and authorized generic) is typically excluded from coverage.

Provider Actions and Requirements

Step Therapy

Step therapy prior authorization requirement

Crexont or Rytary will be approved only when the member has documentation of a history of suboptimal response, a contraindication, or intolerance to at least one of the listed carbidopa/levodopa formulations.

carbidopa/levodopa immediate-release (generic Sinemet)
carbidopa/levodopa controlled-release (generic Sinemet CR)
carbidopa/levodopa/entacapone (generic Stalevo)

Prior Authorization

Required trial of lower-cost alternatives

Member must trial a lower-cost carbidopa/levodopa alternative prior to approval unless there is documented contraindication or intolerance.

Required trial: carbidopa/levodopa immediate-release (generic Sinemet)
Alternatives that satisfy the step: carbidopa/levodopa controlled-release (generic Sinemet CR); carbidopa/levodopa/entacapone (generic Stalevo)

Documentation Required

Permitted documentation for automated approval

Approvals may be granted based on previous claim/medication history, diagnosis codes (ICD-10), and/or claim logic; automated approval and re-approval processes vary by program. Approvals are issued for 12 months. Supply limits and state or federal mandates may apply.

Authorization duration: 12 months
Automated approval may use prior claims, ICD-10 diagnosis, or claim logic
Supply limits may apply; member benefit plan and state/federal requirements may affect coverage

Denial Risk

Denial trigger for unmet step

If the record lacks documentation of a required trial (or documented contraindication/intolerance) of the specified carbidopa/levodopa formulations, the request may be denied.

Denial trigger: no documented history of suboptimal response, contraindication, or intolerance to required prior carbidopa/levodopa formulations

Step Therapy Requirements

Step	Required prior trial / criteria	Coverage action
1	Trial and documented history of suboptimal response, contraindication, or intolerance to ONE of the following: (a) carbidopa/levodopa immediate‑release (generic Sinemet), (b) carbidopa/levodopa controlled‑release (generic Sinemet CR), or (c) carbidopa/levodopa/entacapone (generic Stalevo)	Approve extended‑release carbidopa/levodopa (Crexont or Rytary) for up to 12 months when prior trial criteria are met

Initial Therapy

Initial therapy requirements

Initial step: Trial and documented suboptimal response, contraindication, or intolerance to immediate-release carbidopa/levodopa (generic Sinemet) or listed alternatives (carbidopa/levodopa controlled-release or carbidopa/levodopa/entacapone) is required before extended-release carbidopa/levodopa products (Crexont or Rytary) will be approved

Reauthorization / Continuation Criteria

Reauthorization

Reauthorization rules

Reauthorization: Authorization will be issued for 12 months; state mandates, federal requirements, and the member's benefit plan may affect coverage. Prior claim/medication history or diagnosis codes may be used for automated re-approval.

Supply limits may apply

Definitions

Step Therapy — definition and key points

DefinitionA utilization management program that requires trial of lower-cost alternatives before coverage of a higher-cost medication is authorized.

PurposeEncourage use of lower-cost carbidopa/levodopa immediate-release or other specified alternatives prior to approving extended-release formulations (Crexont, Rytary).

Required actionMember must trial carbidopa/levodopa immediate-release (generic Sinemet) prior to coverage of ER formulations.

ScopeApplies to extended-release carbidopa/levodopa products Crexont and Rytary for adult Parkinsonism indications.

Program typeStep Therapy (utilization management).

Background

Crexont and Rytary are carbidopa/levodopa extended‑release formulations indicated for the treatment of Parkinson’s disease and certain parkinsonian syndromes in adults. The program’s intent is to promote use of lower‑cost immediate‑release or other carbidopa/levodopa formulations before authorizing extended‑release products.

Authorization for approved extended‑release therapy is issued for 12 months; state mandates, federal requirements, and the member’s specific benefit plan may affect coverage and other utilization management programs may also apply.