CELEBREX
| Covered Uses: | All medically accepted indications not otherwise excluded from Part D |
| Exclusion Criteria: | Coverage is not provided for the treatment/prevention of Alzheimer's disease or cancer. |
| Required Medical Information: | Coverage is provided when the pt has previously been unable to tolerate therapy with at least two other different NSAIDs OR is at high risk of NSAID induced adverse GI events evidenced by any of the following: 1. history of peptic ulcer disease, history of NSAID related ulcer, or history of clinically significant GI bleeding or 2. Concomitant therapy with anticoagulants (e.g. warfarin, heparin, or LMWH), chronic use of oral corticosteroids, or Non-aspirin anti-platelet agents (e.g. clopidogrel, ticagrelor, or prasugrel). |
| Age Restrictions: | Patients 65 years of age and older are exempt from the required medical information. For JRA, pt must be 2 years of age or older |
| Prescriber Restrictions: | |
| Coverage Duration: | Lifetime for JRA/ 12 months for all other indications |
| Other Criteria: |
Last Modified on 12/19/2012