Linaclotide (Linzess®)
SELF ADMINISTRATION - ORAL
Indications for Prior Authorization:
Patients must meet the following criteria for the indication(s) above:
Chronic idiopathic constipation (CIC)
- Diagnosis of CIC confirmed by chart note documentation, AND
- 18 years of age or older, AND
- Member has increased fiber intake and tried-failed a stimulant laxative or osmotic laxative as confirmed by chart note documentation, AND
- Member is not concomitantly taking Trulance, Amitiza or Motegrity
Irritable bowel syndrome with constipation (IBS-C)
- Diagnosis of IBS-C confirmed by chart note documentation, AND
- 18 years of age or older, AND
- Member has increased fiber intake and tried-failed an osmotic laxative as confirmed by chart note documentation, AND
- Member is not concomitantly taking Trulance, Amitiza or Motegrity
The following conditions do not meet the criteria for use as established by WHA P&T committee:
Dosing:
Chronic idiopathic constipation (CIC): Oral: 145 mcg once daily; 72 mcg once daily may be used based on patient presentation or tolerability
Irritable bowel syndrome with constipation (IBS-C): Oral 290 mcg once daily
Approval:
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