Antipsychotics, Parenteral
PDL Reference Documents
- Antipsychotics, Parenteral - Oct 05, 2023
- Antipsychotics (Parenteral) - Feb 03, 2022
- Antipsychotic Use in Children - Jun 03, 2021
- Antipsychotics Class Update - Aug 06, 2020
- Antipsychotics Literature Scan - Mar 21, 2019
- Antipsychotics Literature Scan - Sep 27, 2018
- Parenteral Antipsychotics Literature Scan - Sep 28, 2017
- Parenteral Antipsychotics - Sep 29, 2016
- Antipsychotics - May 26, 2016
- Long-Acting Injectable Antipsychotics Abbreviated Class Review - Nov 20, 2014
Drug Use Review Documents
PDL Status Values
Y = preferred
N = non-preferred. Non-preferred drugs listed as N but without clinical drug use criteria are subject to the
Non-Preferred Drugs in Select PDL Classes prior authorization criteria.
New drugs will be listed as N until reviewed by the P&T Committee and are subject to the
New Drug Policy.
V = voluntary non-preferred. Non-preferred mental health drugs are listed as V and prior authorization is not required.
Null (i.e. blank) = indicates the class or specific drug has not been reviewed for PDL placement.
To request a Prior Authorization, please use this form.
| Generic Name | Brand Name | Form | PDL Status |
Current Drug Use Criteria | New Drug Evaluation & Updates |
|---|---|---|---|---|---|
| aripiprazole | ABILIFY ASIMTUFII | SUSER SYR | Y | ||
| aripiprazole | ABILIFY MAINTENA | SUSER SYR | Y | ||
| aripiprazole | ABILIFY MAINTENA | SUSER VIAL | Y | ||
| aripiprazole lauroxil | ARISTADA | SUSER SYR | Y | ||
| aripiprazole lauroxil,submicr. | ARISTADA INITIO | SUSER SYR | Y | ||
| chlorpromazine HCl | CHLORPROMAZINE HCL | AMPUL | Y | Oct 01, 2020 | |
| chlorpromazine HCl | THORAZINE | AMPUL | Y | Oct 01, 2020 | |
| chlorpromazine HCl | CHLORPROMAZINE HCL | VIAL | Y | Oct 01, 2020 | |
| fluphenazine decanoate | FLUPHENAZINE DECANOATE | VIAL | Y | ||
| fluphenazine HCl | FLUPHENAZINE HCL | VIAL | Y | ||
| haloperidol decanoate | HALOPERIDOL DECANOATE 100 | AMPUL | Y | ||
| haloperidol decanoate | HALDOL DECANOATE 100 | AMPUL | Y | ||
| haloperidol decanoate | HALDOL DECANOATE 50 | AMPUL | Y | ||
| haloperidol decanoate | HALOPERIDOL DECANOATE | AMPUL | Y | ||
| haloperidol decanoate | HALOPERIDOL DECANOATE | VIAL | Y | ||
| haloperidol lactate | HALOPERIDOL LACTATE | SYRINGE | Y | ||
| haloperidol lactate | HALOPERIDOL LACTATE | VIAL | Y | ||
| paliperidone palmitate | INVEGA HAFYERA | SYRINGE | Y | ||
| paliperidone palmitate | INVEGA TRINZA | SYRINGE | Y | ||
| paliperidone palmitate | ERZOFRI | SYRINGE | Y | ||
| paliperidone palmitate | INVEGA SUSTENNA | SYRINGE | Y | ||
| risperidone | PERSERIS | SUSER SYR | Y | ||
| risperidone | UZEDY | SUSER SYR | Y | ||
| risperidone microspheres | RISPERDAL CONSTA | VIAL | Y | Quantity Limit | |
| risperidone microspheres | RYKINDO | VIAL | Y | Quantity Limit | |
| risperidone microspheres | RISPERIDONE ER | VIAL | Y | Quantity Limit | |
| olanzapine | OLANZAPINE | VIAL | V | ||
| olanzapine | ZYPREXA | VIAL | V | ||
| olanzapine pamoate | ZYPREXA RELPREVV | VIAL | V | ||
| ziprasidone mesylate | GEODON | VIAL | V | ||
| ziprasidone mesylate | ZIPRASIDONE MESYLATE | VIAL | V |