CurrentNeighborhood Health Plan of Rhode IslandPolicy N/A

Aprepitant

Policy governs coverage of aprepitant 40 mg capsules for non-oncology indications, specifically for prevention of postoperative nausea and vomiting (PONV) in adults, within the Medicaid scope.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyAprepitant

Policy CodePolicy N/A

Change TypeClarified

Effective DateDec 1, 2017

Next Review Date

Key ActionAuthorization of up to 1 month may be granted when aprepitant 40 mg capsules are prescribed for prevention of postoperative nausea and vomiting and the member has no exclusions to the therapy.

SourceLink

POLICY UPDATE CHANGES

Policy lists PONV as the covered non-oncology indication for aprepitant 40 mg capsules with authorization of 1 month.

1Covered Indications

1 moAuthorization Duration

MultipleReviewed Dates

Coverage Summary

Policy governs coverage of aprepitant 40 mg capsules for non-oncology indications within Medicaid. The policy covers use of aprepitant 40 mg capsules for the prevention of postoperative nausea and vomiting (PONV) in adults when authorization criteria are met. Coverage stance: covered_with_criteria. Authorization is limited to 1 month per policy.

Authorization Criteria — Initial Therapy

Authorization Criteria (1 month)

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 (PONV).
Indication must be PONV; adult patients per indication statement.
Member has no exclusions to the prescribed therapy.
Policy applies only if member has no exclusions.

Not Covered / Investigational

All other indications are considered experimental/investigational and are not a covered benefit.

ANY of the following

Use of aprepitant for indications other than prevention of postoperative nausea and vomiting (including treatment of established nausea and vomiting).
Chronic continuous administration of aprepitant.
Not recommended and not covered as it has not been studied and drug interaction profile may change during chronic use.

Aprepitant 40 mg capsules are indicated in adults for the prevention of postoperative nausea and vomiting (PONV). The drug has not been studied for the treatment of established nausea and vomiting. Chronic continuous administration is not recommended due to limited data and because the drug interaction profile may change during chronic continuous use.

Provider Actions

Prior Authorization

Authorization required for 1 month

Authorization of up to 1 month may be granted when aprepitant 40 mg capsules are prescribed for prevention of postoperative nausea and vomiting and the member has no exclusions to the therapy.

Indication: prevention of postoperative nausea and vomiting (PONV) in adults
Member has no exclusions to the prescribed therapy

Denial Risk

Not covered for other indications

Claims for aprepitant for indications other than PONV, for treatment of established nausea and vomiting, or for chronic continuous administration may be denied as experimental/investigational.

treatment of established nausea
chronic continuous use
non-PONV indications

Background

Background: Aprepitant 40 mg capsules are indicated in adults for prevention of postoperative nausea and vomiting (PONV). The agent has not been studied for treatment of established nausea and vomiting. Chronic continuous administration is not recommended because it has not been studied and the drug interaction profile may change during prolonged use.

Revision History

2026-04-01reviewLatest

Revision history shows periodic reviews; latest review 04/2026. Policy lists PONV as the covered non-oncology indication for aprepitant 40 mg capsules with authorization of 1 month. Document states scope: Medicaid.

2017-12-01effective_date

Policy effective 12/2017; establishes coverage for prevention of postoperative nausea and vomiting (PONV) in adults for aprepitant 40 mg capsules with authorization of 1 month when criteria are met.