Nuplazid

Drug - Nuplazid™ (pimavanserin) [Acadia Pharmaceuticals, Inc.]

January 2017

Therapeutic area - Mental Health

Approval criteria

• Patient has been stabilized on Nuplazid (the drug is part of the recipient's current course of treatment) as covered on a previous health insurance plan, and patient is new to Medical Assistance OR
• Patient was started and stabilized on Nuplazid in an acute care setting, such as during a hospitalization or within another place of care that offers acute care services OR
• Patient is 18 years of age or older AND
• Patient has a diagnosis of Parkinson’s disease psychosis AND
• Diagnosis of psychosis was made AFTER the Parkinson’s disease was established AND
• Patient must not have one of these conditions:
  • Dementia-related psychosis
  • Hepatic impairment
  • Severe renal impairment
  • History of cardiac arrhythmias

Quantity limits

68 tablets per 34 days

Questions?

MHCP Provider Call Center 651-431-2700 or 800-366-5411