Pharmacy Clinical Policy Bulletins
Aetna Non-Medicare Prescription Drug Plan
Subject: Alcohol Dependence Products
Campral is currently listed on the Aetna Formulary Exclusions List.* Therefore, Campral is excluded from coverage for members enrolled in prescription drug benefit plans that use a closed formulary, unless a medical exception is granted. Aetna considers Campral to be medically necessary for those members who meet the following criteria:
A. A documented
Acamprosate (Campral) is an agent designed to aid in the treatment of alcohol dependence. It is structurally related to gamma aminobutyric acid (GABA). The exact mechanism of acamprosate is not fully understood, but it is thought to involve the restoration of balance between the glutamate (neuronal excitation) and GABA (neuronal inhibition) neurotransmitter systems. Acamprosate is indicated for the maintenance of abstinence from alcohol in patients who have stopped drinking prior to initiation of the drug. The efficacy of acamprosate in patients who have not undergone alcohol detoxification has not been proven. Acamprosate has not been adequately assessed in polysubstance abusers.
According to the manufacturer:
Disulfiram works by inhibiting aldehyde dehydrogenase, the enzyme responsible for metabolizing acetaldehyde (a toxic metabolite of alcohol). The resulting accumulation of acetaldehyde causes hypotension, flushing, nausea, and vomiting in the person consuming alcohol. There is not much evidence that disulfiram enhances abstinence, but there is some evidence that it reduces drinking days.
Naltrexone is an opioid antagonist used to reduce the pleasurable effects of alcohol. Consumption of alcohol stimulates the release of beta-endorphins which initiates a cascade of events thought to contribute to the positive reinforcing effects of alcohol.3 Use of naltrexone blocks the opioid receptors and some of the rewarding effects of alcohol.
Acamprosate works by a different mechanism than naltrexone or disulfiram to treat alcohol dependence. It's believed to reduce the negative reinforcing effects of alcohol (e.g., tension, anxiety, and dysphoria associated with the absence of alcohol).
Place of Service:
The above policy is based on the following references:
1. AHFS Drug Information® with AHFSfirstReleases®. ( www.statref.com), American Society Of Health-System Pharmacists®, Bethesda, MD. Updated periodically.
January 01, 2013
*P = Preferred
FE = Formulary Excluded
NP = Nonpreferred
PR = Precertification
QL = Quantity Limits
AL = Age Limits
ST = Step-Therapy
‡M EX = Medical Exception
*The lists above are subject to change. Not all programs - for example step-therapy, precertification, and quantity limits - are available in all service areas.
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