VRAYLAR (PDF)
Defines medical necessity criteria, age limits, step therapy/redirection exceptions, dosing limits, continued therapy and non-covered indications for Vraylar (cariprazine) across Commercial, HIM and Medicaid lines of business, with appendices for therapeutic alternatives and state-specific step therapy limitations.
Added indication for adjunctive treatment in MDD per prescribing information.
Revised dosing and pediatric age expansions for bipolar disorder (age ≥10) and schizophrenia (age ≥13) and added 0.5 mg and 0.75 mg capsule strengths per PI.
Added dementia-related psychosis to diagnoses/indications for which coverage is not authorized.
Added redirection bypass for members in States with limitations on step therapy in certain mental health settings and included Appendix D listing states (e.g., AR, TX, NV).
Commercial authorization limit revised to 12 months or duration of request, whichever is less.
Added step therapy bypass for IL HIM per IL HB 5395.
Revised continued therapy criteria to allow continuity of care for all indications.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.