Ziconotide (Prialt)

Aetna covers intrathecal ziconotide (Prialt) as medically necessary for adults with severe chronic pain who require intrathecal therapy and are intolerant of or refractory to other treatments (e.g., systemic analgesics, adjunctive therapies, or intrathecal morphine) when selection criteria/ICD‑10 G89.0–G89.4 are met. It is not medically necessary for patients with pre‑existing psychosis, infection at the infusion site, uncontrolled bleeding diathesis, or spinal canal obstruction, and use for other indications (e.g., autism, epilepsy, migraines, stroke, Irukandji syndrome, primary lateral sclerosis), non‑intrathecal routes, or certain intrathecal drug combinations is considered experimental/investigational and not covered.

"HCPCS J2278 (Injection, ziconotide, 1 mcg) — covered when the selection criteria in the policy are met."

Sign up to see full coverage criteria, indications, and limitations.