Revision |
July 21, 2023 |
Approved criteria:
- Acetylcholinesterase Inhibitors
- Cyclooxygenase-2 Inhibitors
- Histamine H2- Receptor Antagonists
- Ketorolac (oral)
- Leukotriene Receptor Antagonists
- Mecasermin
- Memantine
|
Revision |
April 28, 2023 |
Approved criteria:
- Aerosolized Agents - Metered-Dose Inhalers (MDIs): Anti-Cholinergic Drugs
- Aerosolized Agents - Metered-Dose Inhalers (MDIs): Anti-Inflammatory Drugs
- Aerosolized Agents - Metered-Dose Inhalers (MDIs): Beta2 Adrenergic Drugs (long-acting)
- Aerosolized Agents - Metered-Dose Inhalers (MDIs): Beta2 Adrenergic Drugs (short-acting)
- Anti-Depressants, Oral (other)
- Anti-Depressants, Selective Serotonin Reuptake Inhibitors
|
Revision |
Jan. 20, 2023 |
Approved criteria:
- Angiotensin II Receptor Blockers
- Angiotensin-Converting Enzyme Inhibitors
- Platelet Aggregation Inhibitors
- Proton Pump Inhibitors
- Sedative/Hypnotics
- Serotonin 5-HT1B/1D Receptor Agonists
|
Revision |
Oct. 21, 2022 |
Approved criteria:
- Anti-Diabetic Agents (oral)
- Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder Medications
- Glucagon-like Peptide-1 (GLP-1) Receptor Agonists
- Pramlintide
- Serotonin 5-HT3 Receptor Antagonists for Nausea and Vomiting (oral)
- Substance P/Neurokinin1 Receptor Antagonists
|
Revision |
July 21, 2022 |
Approved criteria:
- Fluoroquinolones (oral)
- Hepatitis C
- Immune globulins
- Non-sedating antihistamines
- Non-steroidal anti-inflammatory drugs
- Rifaximin (Xifaxan)
- Sickle cell disease products
- Skeletal muscle relaxants
|
Revision |
April 22, 2022 |
Approved criteria:
- Benzodiazepines (nonsedative/hypnotics)
- Complement Inhibitor and Enzyme/Protein Replacement Therapy
- Direct oral anticoagulants
- Hydroxy-Methylglutaryl Coenzyme A Reductase Inhibitors
- Ivacaftor (Kalydeco) and Combination Therapy
- Low Molecular-Weight Heparins
- Nebulized Bronchodilators
|
Revision |
Jan. 21, 2022 |
Approved criteria:
- Fentanyl
- Gabapentin
- Hydrocodone Bitartrate/Hydrocodone Polistirex
- Ivaca por (Kalydeco®) and combination therapy
- Topical Calcineurin Inhibitors – Pimecrolimus (Elidel®) and Tacrolimus (Protopic®)
- Tramadol (Utram®)
|
Revision |
Oct. 22, 2021 |
Approved criteria:
- Atypical antipsychotics (long-acting injectable)
- Atypical antipsychotics (oral)
- Exogenous insulin products
- Nitazoxanide (Alinia®)
- Promethazine use in children less than 2 years of age
- Quetiapine (low dose)
|
Revision |
Oct. 20, 2021 |
Added July 23, 2021, approved criteria:
- Acetylcholinesterase inhibitors
- Cyclooxygenase-2 inhibitors
- Histamine H2-receptor antagonists
- Ketorolac (oral)
- Leukotriene receptor antagonists
- Mecasermin
- Memantine
|
Revision |
Oct. 20, 2021 |
Added April 23, 2021, approved criteria:
- Aerosolized agents - metered-dose inhalers (MDIs): anticholinergic drugs
- Aerosolized agents - MDIs: anti-inflammatory drugs
- Aerosolized agents - MDIs: beta2 agonists (long-acting)
- Aerosolized agents - MDIs: beta2 agonists (short-acting)
- Antidepressant drugs – other
- Antidepressant drugs – SSRIs
|
Revision |
Oct. 20, 2021 |
Added Jan. 22, 2021, approved criteria:
- Angiotensin-converting enzyme inhibitors
- Angiotensin II receptor blockers
- Platelet aggregation inhibitors
- Proton pump inhibitors
- Sedative/hypnotics
- Serotonin 5-HT1B/1D receptor agonists
|
Revision |
Oct. 20, 2021 |
Added July 1, 2021, Compendia update |
Baseline |
Oct. 20, 2021 |
Initial publication of content as Retrospective Drug Use Criteria Handbook |