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Coverage Decisions for Drugs

Propranolol (Inderal, Innopran)

Propranolol approved to treat high blood pressure, angina, atrial fibrillation, myocardial infarction, migraine, essential tremor, hypertrophic subaortic stenosis and pheochromocytoma. Propranolol is a non-selective beta-blocker that relaxes blood vessels and slows heart rate. This may result in dizziness, lightheadedness, and drowsiness, especially when starting on the medication or after a dose increase. All workers, and especially those operating heavy or dangerous machinery, should use extreme caution.    

This drug requires prior authorization for coverage (see the Outpatient Drug Formulary). In general, coverage of propranolol depends on whether one or more of the above conditions is accepted. Please see the coverage decision below for off-label use to treat anxiety symptoms.

Coverage decision for anxiety

The department or insurer covers propranolol in doses up to 320mg/day for anxiety symptoms with prior authorization. Propranolol has been shown to be effective in treating somatic symptoms of mild to moderate anxiety, such as tremor and palpitations. However, there is insufficient evidence to support propranolol doses greater than 320mg/day for this indication.

Prior authorization criteria for a 60-day drug trial

  • Anxiety symptoms as documented by Hamilton Rating Scale for Anxiety (HAM-A) or Generalized Anxiety Disorder Screener (GAD-7) and associated with accepted condition,
  • The worker has no contraindication to the use of propranolol (bronchial asthma, cardiogenic shock, sinus bradycardia and greater than 1st degree block,  or known hypersensitivity to propranolol),
  • The worker has no history of adverse events with previous propranolol use AND
  • The worker has no history of congestive heart failure or cardiac arrhythmia.

Prior authorization criteria for continued coverage

Upon request, the department or insurer may authorize continued coverage of propranolol under the following conditions:

  • Documented improvement in anxiety symptoms  by at least 30% as measured by HAM-A or GAD-7 during the trial,
  • The worker has no history of adverse events with previous propranolol use, contraindication, congestive heart failure or cardiac arrhythmia AND
  • The worker’s propranolol dose is ≤ 320mg/day.

 

The department or insurer may authorize a 30-day extension to allow time to taper upon request.
 

For more information:
Contact information.

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