EMSAM® (selegiline transdermal system) (Revised)

By immediately upon receipt of this notice: Billing team and clinical staff must implement prior authorization requirements for all EMSAM® (selegiline transdermal system) prescriptions for Medicare Advantage members. Before submitting claims, verify that: (1) member has documented DSM-5 diagnosis of major depressive disorder with appropriate depression rating scale (PHQ-9, QIDS-SR16, MADRS, or HAM-D); (2) member has documented prior therapy failure, intolerance, or contraindication to at least one generic SSRI (citalopram, fluoxetine, paroxetine, sertraline), generic SNRI (venlafaxine, duloxetine), generic bupropion (75mg/100mg IR, 100mg/150mg/200mg SR, 150mg/300mg XL), or mirtazapine. Include all required documentation in prior authorization requests submitted to Humana. Update billing software to flag EMSAM® prescriptions requiring prior auth. Educate prescribers that claims will be denied without documented evidence of failed first-line antidepressant therapy. Note critical contraindications: do not allow concurrent use with serotonergic drugs (SSRIs, SNRIs, clomipramine, imipramine, meperidine, tramadol, methadone, dextromethorphan), carbamazepine, or in patients with pheochromocytoma. Ensure appropriate washout periods are documented (5 weeks for fluoxetine, 1 week for others before starting EMSAM®; 2 weeks after stopping EMSAM® before starting contraindicated drugs).