Epinephrine Auto-injectors
Drugs - Auvi-Q
epinephrine auto-injector (Authorized Generic of Adrenaclick)
epinephrine auto-injector (Authorized Generic of Epipen and Epipen Jr.)
Epipen, Epipen Jr.
June 2017
Therapeutic area - Anaphylaxis
- Preferred Product: epinephrine auto-injector (Authorized Generic of Epipen and Epipen Jr.)
- Nonpreferred Products: Epipen, Epipen Jr., epinephrine auto-injector (Authorized Generic of Adrenaclick)
- Noncovered Product: Auvi-Q. Auvi-Q is excluded from coverage effective 4/1/2017. Kaleo, the manufacturer of Auvi-Q, terminates its participation in Medicaid Drug Rebate Program effective 4/1/2017
Authorization will be granted for nonpreferred products if the recipient has had a documented:
- Allergic reaction to a specific inactive ingredient in the preferred product
- Adverse reaction to a specific inactive ingredient in the preferred product
- Therapeutic success while taking the non-preferred product and therapeutic failure while taking the preferred product documented by patient diary or medical chart notes
Questions?
MHCP Provider Call Center 651-431-2700 or 800-366-5411