Fluoxetine Tablets (Prozac, Sarafem)

Fluoxetine Tablets (Prozac®, Sarafem®)

SELF ADMINISTRATION

FDA Approved Indications:

• Prozac® (Fluoxetine)
  • Major Depressive Disorder (MDD)
  • Obsessive Compulsive Disorder (OCD)
  • Bulimia nervosa
  • Panic Disorder, with or without agoraphobia
• Sarafem® (Fluoxetine PMDD)
  • Premenstrual dysphoric disorder (PMDD)

Prior authorization criteria:

• Medically appropriate diagnosis for specific product, AND
• Medically appropriate reason for use of the tablets and not the capsules is provided
• Preferred agent is fluoxetine capsules (available as 10 mg, 20 mg and 40 mg)

Approval:

• One year