CAPLYTA (lumateperone) 

SELF ADMINISTRATION - oral

Indications for Prior Authorization:

Caplyta is an atypical antipsychotic indicated for the treatment of:

  • Schizophrenia in adults.
  • Depressive episodes associated with bipolar I or II disorder (bipolar depression) in adults, as monotherapy and as adjunctive therapy with lithium or valproate.
Coverage criteria:

For diagnosis of schizophrenia:

  • Dose does not exceed the maximum FDA recommendation (42 mg once daily); AND
  • 18 years of age or older; AND
  • Patient has a diagnosis of schizophrenia; AND
  • Patient has tried and failed at least two preferred atypical antipsychotics (e.g., risperidone, quetiapine, olanzapine, ziprasidone, aripiprazole, asenapine, paliperidone).

For diagnosis of bipolar disorder:

  • Dose does not exceed the maximum FDA recommendation (42 mg once daily); AND
  • 18 years of age or older; AND
  • Patient has depressive episodes associated with bipolar disorder; AND
  • Trial and failure, contraindication, or intolerance to quetiapine (IR or ER) or olanzapine
Coverage Duration:
  • One year
Authorization is not covered for the following:

The use of this drug for indications not listed in this policy does not meet the coverage criteria established by the Western Health Advantage (WHA) Pharmacy and Therapeutics (P&T) Committee.

Additional Information:
  • Moderate or severe hepatic impairment: avoid use
Policy Updates:
  • 05/19/2020 - Policy reviewed
  • 05/17/2022 - Added criteria approved by P&T for updated indication to treat bipolar indication. Updated format.
References:
  1. Caplyta Prescribing Information. Intra-Cellular Therapies, Inc. New York, NY. April 2022.

Last review date: May 17, 2022

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