Prucalopride (Motegrity™)

SELF ADMINISTRATION

Indications for Prior Authorization:
  • Indicated for the treatment of chronic idiopathic constipation (CIC) in adults
Patients must meet the following criteria for the indication(s) above:
  • Patient is 18 years of age or older, AND
  • Diagnosis of CIC confirmed by chart note documentation, AND
  • Patient has increased fiber intake as confirmed by chart note documentation, AND
  • Patient has tried and failed at least one osmotic laxative or stimulant laxative unless contraindicated or clinically significant adverse effects are experienced, AND
  • Does not have an intestinal perforation or obstruction (e.g. Crohn's disease, ulcerative colitis, and toxic megacolon or megarectum), AND
  • Member is not concomitantly taking Linzess®, Amitiza®, or Trulance®
Dosing:
  • Recommended dose: 2mg once daily
  • CrCl <30mL/min: 1mg once daily
  • ESRD: avoid use
Approval:
  • 1 year

Last review date: July 30, 2020

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