CurrentNeighborhood Health Plan of Rhode IslandPolicy N/A

Aprepitant 40 mg capsules

Covers use of aprepitant 40 mg capsules for prevention of postoperative nausea and vomiting (PONV) in adults as a Medicaid benefit when approval criteria are met; all other indications are considered experimental/investigational and not covered.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyAprepitant 40 mg capsules

Policy CodePolicy N/A

Change TypeRevised (non-material)

Effective DateDec 1, 2012

Next Review Date

Key ActionPrior authorization for up to 1 month may be granted when criteria are met (prescribed for adult PONV and no member exclusions).

POLICY UPDATE CHANGES

Policy reviewed multiple times through 05/2024 with package insert reference July 2024 added.

1Covered Indications (PONV)

MultipleReviewed Dates

All othersNot Covered Indications

Coverage Summary

Covers use of aprepitant 40 mg capsules for prevention of postoperative nausea and vomiting (PONV) in adults as a Medicaid benefit when approval criteria are met; all other indications are considered experimental/investigational and not covered.

Initial Therapy Criteria (Authorization)

Approval Criteria for Aprepitant 40 mg Capsules

Authorization of 1 month may be granted when the following criteria are met:

{

"operator":"all",

"children":[

{

"text":"Prescription is for prevention of postoperative nausea and vomiting (PONV)."

{

"text":"Patient is an adult (age ≥ 18 years)."

{

"text":"Member has no exclusions to the prescribed therapy (e.g., coverage exclusions or contraindications)."

}

]

}

Prior Authorization

Authorization requirement

Prior authorization for up to 1 month may be granted when criteria are met (prescribed for adult PONV and no member exclusions).

Duration: up to 1 month

Not Covered / Investigational

All other indications beyond PONV are not covered:

Chronic use not studied: Chronic continuous administration (not recommended/not studied) — not covered
Treatment of established nausea/vomiting: Treatment of established nausea and vomiting — not covered
Other indications: Any indication that is not FDA-approved or compendial use for PONV — considered experimental/investigational and not a covered benefit

Denial Risk

Not covered indications / denial risk

Chronic continuous administration, treatment of established nausea and vomiting, and any non-FDA/compendial uses beyond PONV are considered experimental/investigational and are not covered.

Provider Actions

Prior Authorization

Prior Authorization Required

Prior authorization for up to 1 month may be granted when criteria are met (prescribed for adult PONV and no member exclusions).

Authorization duration: up to 1 month

Documentation Required

Indication documentation

Provider must document that the prescription is for prevention of postoperative nausea and vomiting in an adult and that there are no member exclusions to therapy.

Must document: prescription is for prevention of PONV in an adult; no member exclusions to therapy.

Clinical Evidence

Reference: Aprepitant capsules [package insert], Torrent Pharma, July 2024.

Note: Chronic continuous administration has not been studied and is not recommended, and treatment of established nausea and vomiting has not been studied; all other indications are considered experimental/investigational and not covered.

Background

Aprepitant 40 mg capsules are indicated for prevention of postoperative nausea and vomiting in adults. Chronic continuous administration and treatment of established nausea and vomiting have not been studied and are not recommended.