Noctiva™

Drug: Noctiva™ (desmopressin) [Avadel Specialty Pharmaceuticals, LLC]

December 2018

Therapeutic Area: Nocturnal polyuria

Approval criteria

• Patient must have a diagnosis of nocturnal polyuria AND
• Patient must be at least 50 years of age AND
• Patient does not have central diabetes insipidus AND
• Patient does not have hemophilia A or von Willebrand disease AND
• Patient is not pregnant AND
• Patient has tried behavioral measures substantiated by supporting document provided at time of request

Denial criteria

• Patient must not have any of the following contraindications:
  • Hyponatremia
  • Polydipsia
  • Primary nocturnal enuresis
  • Current condition that causes fluid or electrolyte imbalance
  • Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
  • Concomitant use of loop diuretics or systemic of inhaled glucocorticoids
  • eGFR < 50 mL/min/1.73m2
  • NYHA Class II-IV CHF
  • Uncontrolled hypertension

Quantity limits

• 1 bottle (3.8 g) per 30 days

Background

Noctiva has not been studied in patients less than 50 years of age.

Questions?

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