- Step Therapy Exists in PA
- Prior Authorization: Health Net Approved Indications and Usage Guidelines: 1. Diagnosis of rheumatoid arthritis, osteoarthritis, acute pain or chronic painful/inflammatory conditions where non-steroidal anti-inflammatory drugs (NSAIDs) are warranted. AND a. Patient demonstrates risk for developing NSAID-induced gastrointestinal (GI) complications (must have at least one of the following risk factors): i. History of GI bleeding (chart note documentation required). ii. History of complicated PUD: GI perforations; GI obstructions; GI bleeding. (chart note documentation required). iii. Concurrent use of one of the following: (oral prednisone, prednisolone, dexamethasone) or warfarin (e.g., Coumadin, Jantoven), platelet inhibitors (e.g., Plavix, Ticlid) or other anticoagulants (e.g., Brilinta, Effient, Xarelto, Eliquis). iv. Age greater than 60. OR b. Patient has recently failed or had clinically significant adverse effects to 2 or more NSAIDs in prescription doses, documented through pharmacy claims or other means AND patient is not currently on other NSAIDs. Authorization Limit: Length of benefit.
- Age Limit: This drug may require prior authorization if your age does not fall within manufacturer, FDA, or clinical recommendations.
At least 60 years old
- Quantity Limit: QL(2 eadaily)
- Health Net Approved Indications and Usage Guidelines: 1. Diagnosis of rheumatoid arthritis, osteoarthritis, acute pain or chronic painful/inflammatory conditions where non-steroidal anti-inflammatory drugs (NSAIDs) are warranted. AND a. Patient demonstrates risk for developing NSAID-induced gastrointestinal (GI) complications (must have at least one of the following risk factors): i. History of GI bleeding (chart note documentation required). ii. History of complicated PUD: GI perforations; GI obstructions; GI bleeding. (chart note documentation required). iii. Concurrent use of one of the following: (oral prednisone, prednisolone, dexamethasone) or warfarin (e.g., Coumadin, Jantoven), platelet inhibitors (e.g., Plavix, Ticlid) or other anticoagulants (e.g., Brilinta, Effient, Xarelto, Eliquis). iv. Age greater than 60. OR b. Patient has recently failed or had clinically significant adverse effects to 2 or more NSAIDs in prescription doses, documented through pharmacy claims or other means AND patient is not currently on other NSAIDs. Authorization Limit: Length of benefit.
- Step Therapy: Step Therapy Exists in PA
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