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