Austedo® & Austedo® XR (deutetrabenazine) (Revised)

By effective date of requests (ongoing): Billing and prior authorization team must implement the following: (1) Require prior authorization for all Austedo and Austedo XR (deutetrabenazine) claims on Medicare Advantage plans; (2) For tardive dyskinesia claims, verify documentation that either the dopamine receptor-blocking agent has been discontinued/reduced OR discontinuation/reduction is not possible, OR the condition is not associated with dopamine receptor-blocking agents; (3) For Huntington's disease claims, verify diagnosis of chorea associated with Huntington's disease; (4) Ensure prescriber documentation addresses black box warning for depression and suicidality in Huntington's disease patients and confirms patient is not suicidal or has untreated/inadequately treated depression; (5) Verify no contraindicated medications (reserpine, MAOIs, tetrabenazine, valbenazine) and no hepatic impairment; (6) Confirm dose does not exceed 36 mg daily if patient is on strong CYP2D6 inhibitors or is a poor CYP2D6 metabolizer; (7) Document any treatment interruptions greater than one week require re-titration upon resumption. Update prior authorization request forms and system workflows to capture these criteria. Denials will result if prior authorization is not obtained or criteria are not met.