WHA

Journavx (suzetrigine) - Quantity Limit Override

Indications for Prior Authorization

Journavx (suzetrigine)
  • For diagnosis of Acute Pain
    Indicated for the treatment of moderate to severe acute pain in adults.

Criteria

Journavx*

*QL is hard coded for 30 tablets per 90 days. Do not approve for greater than an additional 30 tablets per request.

Quantity Limit

Length of Approval: 14 Day(s)

  • Patient is experiencing a new episode of moderate to severe acute pain [b]
    • AND
  • Medication will not be used for longer than 14 days for any one acute pain occurrence [c]
    • AND
  • Dosing frequency will be limited to twice daily
    • AND
  • Medication is not used in combination with opioid products (e.g., oxycodone, hydrocodone, codeine)

  • Guideline ID
    GL-222187

  • Formulary
    premium

  • Effective date
    Apr 1, 2025

  • P&T approval date
    Nov 21, 2024

P & T Revisions

2025-03-21, 2025-03-10, 2025-02-21, 2025-02-10

  1. J Jones et al. Selective Inhibition of NaV1.8 with VX-548 for Acute Pain. N Engl J Med 2023;389:393-405. DOI: 10.1056/NEJMoa2209870. August 2023
  2. D Dowell et al. Prescribing Opioids for Pain — The New CDC Clinical Practice Guideline. N Engl J Med 2022;387:2011-2013. DOI: 10. 1056/NEJMp221104. Novemebr 2023
  3. Journavx Prescribing Information. Vertex Pharaceuticals Inc. Bostom MA. January 2025.
  1. The CDC defines acute pain as pain with a duration of less than 1 month. (2)
  2. The Numerical Rating Scale (NPRS-11) is an 11-point scale for self-report of pain. It is the most used unidimensional pain scale. The respondent selects a whole number (integers 0 – 10) that best reflects the intensity (or other quality if requested of his/her pain. It is categorized into no pain = 0, mild pain = 1-3, moderate pain = 4-6, severe pain = 7-10. Moderate to severe pain is evidenced by a score of greater than or equal to 4 on the Numeric Pain Rating Scale (NPRS). (1)
  3. Suzetrigine was studied and found to be well tolerated for up to 14 days use at one time. (1)
  • 2025-03-21: Added EHB formulary to Guideline.
  • 2025-03-10: Addition of QL note, requested by PA Ops.
  • 2025-02-21: QL override criteria approved at Nov 2024 P&T in place.
  • 2025-02-10: New Program.