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Cox-II Inhibitors
Utilization Management
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- Utilization Management Guidelines
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Guidelines
Use the table below to review the guidelines associated with Cox-II Inhibitors:
| Drug Name |
Preliminary Criteria |
Prior Authorization Requirement |
Bextra
Celebrex |
Patient age is less than 60 years old |
Prior Authorization required for coverage and quantity limits applied.
The safety and efficacy of Cox-II inhibitors has not been established in patients younger than 18 years of age. |
Bextra
Celebrex |
Patient age is 60 years old or older |
Prior Authorization required for requests of quantities greater than outlined in the quantity limit guidelines. |
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Prior Authorization Criteria
Use the table below to establish Prior Authorization criteria:
| Patient Diagnosis |
And One of the Following |
Or... |
- Rheumatoid arthritis
- Osteoarthritis
- Degenerative joint disease (DJD)
- Chronic/persistent inflammatory disease
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- Patient has documented evidence of peptic ulcer disease
- Patient had documentation of upper GI bleed
- Patient on anti-coagulation therapy (i.e. Coumadin)
- Patient on concomitant chronic (>3 months) systemic glucocorticoid therapy
- Patient has documented blood dyscrasias that increase risk of bleeding
- Evidence is presented documenting that the patient has failed one prescription
NSAID because of GI disturbance within the last six months
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- Using Celebrex, for reduction in colorectal polyps (related to familial adenomatous polyposis)
- Post operative patients will be eligible for one month of Cox-II therapy
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Quantity Limits
Use the table below to determine quantity limits:
| Brand Name |
Quantity Limit |
| Bextra (valdecoxib) |
30 tablets per 30 days |
| Celebrex (celecoxib) |
60 capsules per 30 days |
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Nonsteroidal Anti-inflammatory Drug Costs
Use the table below to determine anti-inflammatory drug costs:
| Brand Name |
Cost per Unit |
Generic Equivalent |
Cost per Unit |
| Bextra |
3.05 |
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| Celebrex |
2.88 |
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| Motrin |
0.40 |
ibuprofen |
0.09 |
| Naprosyn |
1.26 |
naproxen |
0.20 |
| Voltaren |
2.18 |
diclofenac sodium |
0.34 |
| Indocin |
0.67 |
indomethacin |
0.09 |
| Anaprox |
1.15 |
naproxen sodium |
0.29 |
| Mobic |
2.72 |
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| Lodine |
1.70 |
etodolac |
0.32 |
| Relafen |
1.53 |
nabumetone |
1.13 |
Brand cost estimates are AWP from Medispan as of May 7, 2003, and the generic cost estimates are Wellmark MAC prices.
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References
- Bombardier C, Laine L, Reicin A, et al. Comparison of upper gastrointestinal
toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis.
N Engl J Med. 2003;343(21):1520-1528.
- Emergy P. Cyclooxygenase-2: a major therapeutic advance? AM J Med.
2001;110(1 Suppl 1):S42-S45.
- Mukherjee D, Nissen SE, Topol EJ. Risk of cardiovascular events associated
with selective COX-2 inhibitors. JAMA. 2001;286(8):954-959.
- Silverstein FE, Faich G., Goldstein JL, et al. Gastrointestinal toxicity
with celecoxib vs. nonsteroidal anti-inflammatory drugs for osteoarthritis
and rheumatoid arthritis: the CLASS study: A randomized controlled trial.
Celecoxib Long-term Arthritis Safety Study. JAMA. 2000;284(10):1247-1255.
- www.bextra.com/physicians_prescribing_information-31.asp
- www.celebrex.com/healthcare/u2_prescribing_information.asp.
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