WHA

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

Step Therapy

Length of Approval: 12 Month(s)

  • 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

  • Guideline ID
    GL-148469

  • Formulary
    Premium

  • Effective date
    Sep 1, 2024

  • P&T approval date
    Jul 20, 2022

P & T Revisions

2024-06-13, 2023-06-19, 2022-10-31

  1. Viibryd prescribing information. Allergan USA, Inc. Madison, NJ. September 2021.
  • 2024-06-13: 2024 Annual Review
  • 2023-06-19: 2023 Annual Review
  • 2022-10-31: New UM Criteria

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