CurrentUnitedHealthcarePolicy N/A

Azilect (rasagiline) step therapy

This policy governs prior authorization step therapy requirements for Azilect (rasagiline) under UnitedHealthcare's Essential PDL, requiring trial of a lower-cost alternative before coverage. It affects providers seeking coverage for Azilect for UnitedHealthcare members in North Carolina.

Policy Summary

PayerUnitedHealthcare

PolicyAzilect (rasagiline) step therapy

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJun 1, 2025

Next Review DateN/A

Key ActionObtain prior authorization and document failure, contraindication, or intolerance to selegiline before requesting coverage for Azilect.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

12 monthsauthorization duration

Essential PDLprogram scope

selegilinerequired step agent

2016-2025P&T review range

Coverage Criteria for Azilect (rasagiline)

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Provider Actions and Authorization

Prior Authorization

Prior Authorization Required

Prior authorization is required for Azilect. Authorization will be issued for 12 months after documentation of failure, contraindication, or intolerance to the lower-cost alternative. State mandates, federal regulatory requirements, and member-specific benefit plan coverage may affect authorization.

Authorization duration: 12 months

Step Therapy

Step Therapy Requirement

Member must try the lower-cost generic alternative selegiline (generic Eldepryl) prior to coverage of Azilect. Approval will be granted only if there is documented failure, contraindication, or intolerance to selegiline.

Required prior agent: selegiline (generic Eldepryl)

Documentation Required

Required Documentation

Document the history of failure, contraindication, or intolerance to selegiline. Include the specific reason for therapeutic failure, the nature of the contraindication, or details of the intolerance in the clinical record and prior authorization submission.

Documented reason for failure/contraindication/intolerance to selegiline must be provided

Denial Risk

Step Therapy Failure Risk

Coverage may be denied if the member has not tried and failed selegiline, is not intolerant of it, or does not have a documented contraindication to the lower-cost agent. Ensure prior therapy and documentation meet criteria to avoid denial.

Denial risk if no documented trial/failure or contraindication/intolerance to selegiline

Initial Therapy Requirements

Initial therapy requirements

Authorization criteria for initiating Azilect:

Initial therapy: Documented history of failure, contraindication, or intolerance to selegiline (generic Eldepryl); include the reason for therapeutic failure, contraindication, or intolerance

Prior authorization is required; approval will be issued for 12 months

Step	Requirement	Coverage
1	Trial of selegiline (generic Eldepryl): member must have history of failure, contraindication, or intolerance to selegiline with the reason documented	Covered when requirement met

Definitions

Step Therapy definition

DefinitionStep Therapy: A utilization management program that requires trying lower-cost alternatives before coverage of a higher-cost medication.

PurposeEncourages use of lower-cost alternatives within a therapeutic class by requiring a trial of the lower-cost agent prior to coverage of the brand medication.

Example requirement for AzilectMember must try selegiline (generic Eldepryl) prior to coverage of brand Azilect; documented failure, contraindication, or intolerance to selegiline is required.

DocumentationDocument the reason for therapeutic failure, contraindication, or intolerance to the lower-cost alternative.

Scope noteThis step therapy program applies to requiring the generic alternative before authorization of brand Azilect.

Background

Step therapy programs are used to encourage use of lower-cost alternatives within a therapeutic class. For Azilect (rasagiline), this program requires a trial of the lower-cost alternative selegiline (generic Eldepryl) prior to coverage of Azilect, unless there is a documented failure, contraindication, or intolerance to selegiline. The rationale is to promote cost-effective therapy by ensuring members have attempted an appropriate, less costly option before authorizing the brand medication under the Essential PDL.

Prior authorization is required for Azilect; when approved after documentation of failure, contraindication, or intolerance to selegiline, authorization will be issued for 12 months. Providers should document the reason for therapeutic failure, contraindication, or intolerance to support approval.