CNS Stimulants - Methylphenidate

Covered Uses:	All FDA approved indications not otherwise excluded from Part D. Additional off-label coverage is provided for depression, and narcolepsy.
Exclusion Criteria:
Required Medical Information:	Coverage for ADD/ADHD is provided in situations in which the diagnosis of ADD/ADHD has been confirmed using established criteria such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) based ADHD rating scales such as Conners Comprehensive Behavior rating scale or ADHD rating scale IV or other criteria deemed appropriate by the prescriber. Coverage for narcolepsy is provided in situations in which there are no conditions contributing to or worsening symptoms of narcolepsy (e.g., nocturnal myoclonus, sedating drugs or drugs interfering with sleep, substance abuse, or chronic voluntary or involuntary sleep deprivation) or in situations in which the underlying conditions have been have been addressed or treated. Coverage for idiopathic hypersomnolence is provided in situations in which the diagnosis of idiopathic hypersomnolence has been confirmed by sleep studies (polysomnography) in order to rule out disorders such as narcolepsy, obstructive sleep apnea or posttraumatic hypersomnia.
Age Restrictions:
Prescriber Restrictions:
Coverage Duration:	12 months
Other Criteria:

Last Modified on 12/19/2012