Gocovri™

Drug - Gocovri™ (amantadine extended-release) [Adamas Pharma, LLC.]

July 2018

Therapeutic area - Parkinson’s disease

Approval criteria

Patient is ≥ 18 years of age AND
Patient must have dyskinesia associated with Parkinson’s disease AND
Patient must be on concomitant levodopa-based therapy AND
Patient has had an adequate trial of or is intolerant to amantadine immediate-release AND
Patient does not have end-stage renal disease (creatinine clearance < 15 mL/min/1.73 m2)

Renewal criteria

Patient continues to meet criteria defined for initial approval AND
Absence of unacceptable toxicity from the drug (e.g., hallucinations, falls, orthostatic hypotension, dizziness, anticholinergic effects, peripheral edema)

Quantity limits

68.5 mg: 30 capsules / 30 days
137 mg: 60 capsules / 30 days

Questions?

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