Apokyn

Indications for Prior Authorization

Apokyn (apomorphine injection)
  • For diagnosis of Parkinson’s Disease
    Indicated for the acute, intermittent treatment of hypomobility, “off” episodes (“end-of-dose wearing off” and unpredictable “on/off” episodes) in patients with advanced Parkinson’s disease. Apokyn has been studied as an adjunct to other medications.

Criteria

Generic apomorphine hydrochloride inj

Prior Authorization (Initial Authorization)

Length of Approval: 12 Month(s)

  • Diagnosis of Parkinson’s disease
  • AND
  • Patient is experiencing intermittent OFF episodes
  • AND
  • One of the following:
    • Patient is receiving drug in combination with carbidopa/levodopa at a maximally tolerated dose
    • OR
    • Patient has a contraindication or intolerance to carbidopa/levodopa
    AND
  • Trial and failure (of a minimum 30 day supply), contraindication or intolerance to two of the following: [A]
    • MAO-B Inhibitor (e.g., rasagiline, selegiline)
    • Dopamine Agonist (e.g., pramipexole, ropinirole)
    • COMT Inhibitor (e.g., entacapone)
    AND
  • Not used with any 5-HT3 antagonist (e.g., ondansetron, granisetron, dolasetron, palonosetron, alosetron)
  • AND
  • Prescribed by or in consultation with a neurologist
Generic apomorphine hydrochloride inj

Prior Authorization (Reauthorization)

Length of Approval: 12 Month(s)

  • Documentation of positive clinical response to therapy
P & T Revisions

2024-02-14, 2023-03-16, 2022-01-25, 2021-09-27, 2021-05-10, 2021-03-12, 2020-11-25, 2020-09-30, 2020-07-27, 2020-03-05

  1. Apokyn prescribing information. US WorldMeds, LLC. Louisville, KY. June 2022.
  2. Obering CD, Chen JJ, Swope DM. Update on apomorphine for the rapid treatment of hypomobility ("off") episodes in Parkinson's disease. Pharmacotherapy. 2006;26(6):840-852.
  3. Per clinical consult with neurologist, March 27, 2019.

  1. Primary treatment options for patients experiencing intermittent OFF episodes depends on the severity of the episodes. The easiest options include: shortening the dosing interval of levodopa, advising patient to take levodopa on an empty stomach if possible, or crushing the tablet and ingesting it with carbonated water for more predictable and faster absorption. Following the trial of the above options, entacapone, MAO-B Inhibtors or Dopamine Agonists may be added to the patient's therapy to enhance dopamine levels. [3]

  • 2024-02-14: 2024 Annual Review
  • 2023-03-16: 2023 Annual Review.
  • 2022-01-25: 2022 Annual Review
  • 2021-09-27: EHB Specific Guideline - No changes to criteria
  • 2021-05-10: EHB Specific Guideline
  • 2021-03-12: Program Update to add step through Kynmobi and Inbrija for Apokyn
  • 2020-11-25: Program Update: OFF episode criterion simplified, and embedded step revised
  • 2020-09-30: Program Update
  • 2020-07-27: Program Update: added new product Kynmobi to GL, renamed GL Apomorphine Products
  • 2020-03-05: Annual Review