SELECTIVE SEROTONIN REUPTAKE INHIBITOR (SSRI)

STEP THERAPY

The SSRI step therapy program support the coverage of a single source SSRI (BRAND) after the use of a generic SSRI within 130 days (4 months), while not interrupting existing therapy. This step therapy program will exclude children 18 years of age or younger.

SARAFEM (fluoxetine) will not be covered and there are no exceptions.

If the step therapy rule is not met at the point of service (when the prescription is processed at the pharmacy), the pharmacy will need to call the practitioner to determine if a first-line SSRI could be prescribed. Should the practitioner choose to use the second-line SSRI without meeting the step criteria, and the participant wants the prescription given special consideration for payment from their prescription drug benefit, the practitioner must contact HealthCare Services at MAHP and provide additional medical/clinical information . If the medical/clinical information meets criteria for a medical exception to this step therapy, a prior authorization may be granted.

   *PROZAC (Fluoxetine) does not have an indication for anxiety. If the office mentions or documents indicate an anxiety component thensuggest Celexa or Paxil for first line.

	FIRST-LINE DRUGS	SECOND-LINE DRUGS
MEDICATIONS	Fluoxetine (PROZAC) Fluvoxamine (LUVOX) Citalopram (CELEXA) Paroxetine (PAXIL)	Sertraline (ZOLOFT) Escitalopram Oxalate (LEXAPRO)
CRITERIA FOR USE	Driven by formulary status of drug, formulary is closed and MAC policies **Processing of brand name first-line drug will cause ancillary charges to participant	Partipant has one RX in claims history from the first-line drug category within 130 days prior to the prescription date of an SSRI from second-line category OR Participant has a prescription claims history of an SSRI in second-line category within 130 days OR Participant is < 19 years old.

Kt 05/11/05