CurrentNeighborhood Health Plan of Rhode IslandPolicy N/A

Aprepitant 40 mg capsules for prevention of postoperative nausea and vomiting (PONV)

Policy defines coverage for Aprepitant 40 mg capsules for non-oncology indications, specifically for prevention of postoperative nausea and vomiting (PONV), with approval criteria, limitations, and duration of authorization.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyAprepitant 40 mg capsules for prevention of postoperative nausea and vomiting (PONV)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateDec 1, 2017

Next Review Date

Key ActionAuthorization of 1 month may be granted when Aprepitant 40 mg capsules are prescribed for prevention of postoperative nausea and vomiting; provider must document indication; ensure member has no exclusions to the prescribed therapy.

POLICY UPDATE CHANGES

No material changes

1Covered Indication (non-oncology)

2Not covered / limitations listed

Coverage Summary

Policy defines coverage for Aprepitant 40 mg capsules for non‑oncology use specifically for the prevention of postoperative nausea and vomiting (PONV) in adults. Authorization of 1 month may be granted when criteria are met. Subject: Aprepitant 40 mg capsules for prevention of postoperative nausea and vomiting (PONV). Effective: 2017-12-01; Last review: 2024-05-01.

Criteria for Approval

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

ALL of the following

Aprepitant 40 mg capsules are being prescribed for the prevention of postoperative nausea and vomiting

Authorization duration: Authorization of 1 month may be granted

Limitations of Use / Non-Covered Indications

The following are limitations or not covered:

ANY of the following

Not studied for treatment of established nausea/vomiting: Aprepitant has not been studied for the treatment of established nausea and vomiting
Not an approved indication for treatment of established nausea/vomiting
Chronic use not recommended / not covered: Chronic continuous administration of Aprepitant is not recommended (not studied; drug interaction profile may change during chronic use)
Chronic continuous use not recommended / not covered
Other indications experimental/investigational: All other indications (outside FDA-approved and compendial uses listed) are considered experimental/investigational and are not a covered benefit
Non-listed indications are not covered

Provider Actions

Prior Authorization

Authorization required

Authorization of 1 month may be granted when Aprepitant 40 mg capsules are prescribed for prevention of postoperative nausea and vomiting; provider must document indication; ensure member has no exclusions to the prescribed therapy.

Documentation Required

Document indication and avoid chronic use

Provider should document PONV prevention indication; chronic continuous administration is not recommended and is not a covered benefit.

Clinical Evidence

Reference: Aprepitant capsules [package insert], Torrent Pharma; July 2024. The policy restricts use to the FDA‑indicated PONV indication and authorizes a one‑month course when prescribed for prevention of postoperative nausea and vomiting. The policy notes that Aprepitant has not been studied for treatment of established nausea and vomiting and that chronic continuous administration is not recommended (not studied and drug interaction profile may change), so those uses are not covered.