Drug/Drug Class:

Abilify Discmelt (Aripipazole) Rapid Dissolve Tablet / Atypical Antipsychotic Agent

Prepared for:

Missouri Medicaid

Prepared by:

ACS - Heritage Information Systems, Inc.

Purpose:

The purpose of this monograph is to provide a review of new therapy to determine whether the reviewed drug should be made available on an open access basis to prescribers, require a clinical edit or require prior authorization for use.

Dosage Forms:

Each rapid dissolve tablet of Abilify Discmelt 15 mg contains 15 mg of Aripiprazole and each rapid dissolve tablet of Abilify Discmelt 10 mg contains 10 mg of Aripiprazole.

Manufacturer:

Otsuka America Pharmacetuical, Inc., Rockville, MD 20850

Indications:

Abilify Discmelt rapid dissolve tablet is indicated for the treatment of schizophrenia and for the treatment of acute manic and mixed episodes associated with Bipolar Disorder.

Costs:

$12.20 per rapid dissolve tablet of Abilify Discmelt 10 mg WAC

$12.20 per rapid dissolve tablet of Abilify Discmelt 15 mg WAC

Summary of Findings:

A 15 day limitation clinical edit is in place for this class of drug therefore the Division recommends adding this dose form to the 15 day limitation clinical edit.

Status Recommendation:

Prior Authorization (PA) Required

Clinical Edit

Open Access

PDL

Type of PA Criteria:

Increased Risk of ADE

Appropriate Indications

Non-Preferred Agent

PA not required

Prepared By: Mark M. Roaseau, BS Pharmacy, MD

Date: November 10, 2006