H (400 MHz, MeOD): 4.77 (1 H, dd, J = 9.5, 4.4 Hz, H-4), 4.04 (1 H, t, J = 6.3 Hz, H-1), 3.90 (1 H, d, J = 17.7 Hz, H-6 A or B ), 3.85 (1 H, d, J = 17.7 Hz, H-6 A or B ), 3.483.36 (4 H, m, PCH 2 + H-7), 3.323.25 (1 H, m, H-5 A or B partially obscured by residual peaks in NMR solvent), 3.243.15 (2 H, m, H-8), 2.95 (1 H, dd, J = 13.9, 9.5 Hz, H-5 A or B ), 2.58 (2 H, t, J = 7.1 Hz, H-3), 2.312.11 (2 H, m, H-2), 1.781.65 (2 H, m, CH 2 ), 1.651.52 (4 H, m, CH 2 )
If these criteria are satisfied, CVS will approve the medication, but it also employs step therapy to promote cost-effective options
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In some cases, clinician-recommended antiemetic strategies may also be helpful
