Harvard Pilgrim has enacted a step therapy requirement on the Premium formulary for members beginning treatment with Vraylar (cariprazine), an oral atypical antipsychotic used in adults for the treatment of manic or mixed episodes associated with bipolar I disorder or schizophrenia. Vraylar is not covered on the Value formulary.
Effective immediately, Harvard Pilgrim offers coverage for Vraylar on the Premium formulary provided that it is medically necessary and the member has completed and failed a one-month trial of aripiprazole and one other atypical antipsychotic. Harvard Pilgrim will continue to cover Vraylar for patients who are currently using Vraylar or have used it in the past year. For more information, please refer to the Vraylar Clinical Criteria.
A prior authorization is only required if the member does not meet the step therapy requirement or is on the Value formulary. To request prior authorization, please complete the Vraylar Medication Request Form and fax it to MedImpact Healthcare Systems at 888-807-6643.