Xenazine policy criteria

[chantell.reagan]

The FDA approved Xenazine (tetrabenazine) as the first treatment for chorea associated with Huntington’s disease. We located 6 publically available prior authorization policies issued by local and national plans for their coverage determinations for Xenazine. The following are our key findings:

oAll plans require a diagnosis of chorea associated with Huntington's disease; however, only 1 plan allows off-label uses listed by compendia (chronic tics (Tourette’s syndrome) and tardive dyskinesia)
o4/6 plans require diagnosis and/or management by neurologist
oPA criteria tended to vary in terms of requirements for participation in REMS programs (2/6 plans) or absence of contraindications (2/6 plans)
oQuantity limits ranged from #60-240 tablets per month

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Of note, there is 1 oral agent in the late-stage pipeline, eicosapentaenoic acid by Amarin, which is targeted to enter the market after 2011/2012.

Sources:

Xenazine prescribing information

DrugPipelineForecast

BCBS of Michigan. Prior Authorization/Step Therapy Program 7/09

Coventry. Xenaxine coverage policy

Excellus. Clinical Review Prior Authorization (CRPA)

The Regence Group. Xenazine policy

Horizon BCBS NJ. Xenaxine medical necessity guideline

Aetna. Clinical Policy Bulletin: Xenazine