New Drug Class for Selective Constipation Agents

Effective Sept. 27, 2020, updated clinical criteria for Relistor tablets and vial/syringe will be in place.

Relistor tablets are covered for beneficiaries 18 years of age or older with diagnosis of opioid-induced constipation with chronic non-cancer pain (including beneficiaries with chronic pain related to prior cancer or its treatment who do not require frequent opioid dosage escalation) and the beneficiary:

• does not have known or suspected mechanical gastrointestinal obstruction
• has received opioids for at least four weeks in duration
• has tried and failed or has contradiction or intolerance to Amitiza AND Movantik
• initial approval shall be for up to four months.

Relistor vial/syringe is covered for beneficiaries 18 years of age or older with a diagnosis of opioid induced constipation with one of the following:

• chronic non-cancer pain (including patients with chronic pain related to prior cancer or its treatment who do not require frequent opioid dosage escalation) OR
• advanced illness or pain caused by active cancer who require opioid dosage escalation for palliative care

AND

• does not have known or suspected mechanical gastrointestinal obstruction
• has received opioids for at least four weeks in duration
• has tried and failed or has contradiction or intolerance to Amitiza AND Movantik
• initial approval shall be for up to four months.