Pharmacy Prior Authorization Criteria

Viibryd (vilazodone)

Indications for Prior Authorization

Viibryd (vilazodone)

• For diagnosis of Major Depressive Disorder
  Indicated for the treatment of major depressive disorder (MDD) in adults.

Criteria

Brand Viibryd

For reauthorization request, bypass criteria review and approve through 12/31/2039 For state-mandated plans in Illinois or other states where applicable: Step therapy requirements do NOT apply. Beginning January 1, 2026, step therapy requirements or use of the authorization of alternative covered medications in a manner that effectively creates a step therapy requirement will not be imposed.

Step Therapy

Length of Approval: When approved; no reauthorization required

• Requested drug is being used for a Food and Drug Administration (FDA)-approved indication
AND
• Trial and failure (of a minimum 30-day supply), or intolerance to generic vilazodone

P & T Revisions

1970-01-01, 2025-12-18, 2025-07-02, 2025-05-29, 2024-06-13, 2023-06-19, 2022-10-31

References

1. Viibryd prescribing information. Allergan USA, Inc. Madison, NJ. October 2023.

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Revision History

• 1970-01-01: No criteria changes
• 2025-12-18: no criteria changes, added IL statute operational note
• 2025-07-02: 2025 Annual Review. No criteria changes. Updated references.
• 2025-05-29: Removing reauthorization requirement as part of extended reauthorization program.
• 2024-06-13: 2024 Annual Review
• 2023-06-19: 2023 Annual Review
• 2022-10-31: New UM Criteria

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