Constipation Linzess

By | May 29, 2016

State of Idaho, Division of Medicaid. Linzess® is the preferred agent. For chronic constipation, Linzess® is the preferred agent. Non-preferred agent (Amitiza®) requires trial and failure of the preferred agent or medical justification.

Amitiza (lubiprostone) is indicated for the treatment of chronic idiopathic constipation, Linzess (linaclotide) is indicated for the treatment of chronic idiopathic constipation and irritable bowel syndrome with constipation in adults aged 18 years and older.

AMITIZA & LINZESSTM PREAUTHORIZATION REQUEST PHYSICIAN FAX FORM Only the prescriber may complete this form. This form is for prospective, concurrent, and retrospective reviews. Irritable Bowel Syndrome with constipation Chronic Idiopathic Constipation

Linaclotide is a guanylate cyclase-C agonist that was FDA-approved in adults for the treatment of chronic idiopathic constipation and irritable bowel syndrome characterized by constipation. (1966 to August 2004) using the search terms linaclotide and Linzess.

Linzess_Form 1 Rev 06172015 Mail requests to: Linzess Coverage Determination . FOR PROVIDER USE ONLY. Prescription Information. Is the customer diagnosis Chronic Idiopathic Constipation? Yes No. INT_14_23275 Linzess_Form 2 Rev 06172015

constipation has also been linked to impaired quality of life ( 4 ), most notably among the elderly ( 5 ). Neither IBS nor CIC are associated with abnormal radiologic or endoscopic abnormalities, nor are they associated with a

Drugs to Treat Constipation • Consumer Reports Best Buy Drugs• 3 This report compares the effectiveness, safety, and cost of medicines used

Prior Authorization Approval Criteria Linzess (linaclotide) Generic name: linaclotide Brand name: Linzess Medication class: guanylate cyclase-C agonist FDA-approved uses following symptoms of constipation for at least 6 months:

Linaclotide (Linzess®) 2 Forest . Treatment of chronic idiopathic constipation (CIC) Treatment of irritable bowel syndrome with constipation (IBS-C) lubiprostone (Amitiza®) 3 Takeda . Treatment of chronic idiopathic constipation (CIC)

Amitiza Linzess Movantik . Strength Dosage Instructions Quantity Days Supply. Treatment failures: Saline Laxative (milk of magnesia) Trial: Microsoft Word – Oral Constipation Agents PA Form NPI Jan 16.doc Author: skelley

Request for Prior Authorization – Lubiprostone (Amitiza®) and Linaclotide (Linzess®) • Treatment of chronic idiopathic constipation with no age restriction. • Irritable bowel syndrome with constipation General Requirements

Irritable Bowel Syndrome with Constipation (IBS-C) Linzess is indicated in adults for the treatment of irritable bowel syndrome with constipation (IBS-C). Chronic Idiopathic Constipation (CIC)

Prior Authorization Approval Criteria Linzess Brand name: Linzess Medication class: guanylate cyclase-C agonist FDA-approved uses: Chronic idiopathic constipation (CIC) following symptoms of constipation for at least 6 months:

Prescription medication options are limited for patients with chronic idiopathic constipation (CIC) or irritable bowel syndrome with a constipation component (IBS-C).

Medication Guide. Revised: August 2012 . FULL PRESCRIBING INFORMATION: CONTENTS* WARNING: PEDIATRIC RISK Irritable Bowel Syndrome with Constipation (IBS-C) LINZESS (linaclotide) is indicated in adults for the treatment of irritable bowel syndrome with constipation

ORAL CONSTIPATION AGENTS (PLEASE PRINT – ACCURACY IS IMPORTANT) Amitiza Linzess Movantik . Documentation the patient is not currently taking constipation causing therapies: Medication review completed: Yes No

Linzess_Form 1 Rev 06172015 Mail requests to: Linzess Coverage Determination . FOR PROVIDER USE ONLY. Prescription Information. Is the customer diagnosis Chronic Idiopathic Constipation? Yes No. INT_14_23275 Linzess_Form 2 Rev 06172015

Linaclotide (Linzess®) 2 Forest . Treatment of chronic idiopathic constipation (CIC) Treatment of irritable bowel syndrome with constipation (IBS-C) lubiprostone (Amitiza®) 3 Sucampo . Treatment of chronic idiopathic constipation (CIC)

Prior Authorization Form Amitiza This fax machine is located in a secure location as required by HIPAA regulations. Complete/review information, sign and date.

Leave a Reply