Benefits Plans - Prescription Drug Plan: Drug Plan Updates and New Drug Releases -
COX-2 (Celebrex®, Vioxx®, and Bextra®) Step Therapy to begin October 1
In the continuing effort to promote effective use of prescription drugs, the U-M Employee Prescription Plan is implementing a change to the pharmacy benefit for all U-M employees and retirees. Effective on October 1, 2004, step therapy for COX-2 inhibitors will begin. This therapy is a ‘step’ approach to providing pharmaceutical treatment and may require the member to use a "first-line" drug before authorization is granted for a more costly "second-line" drug. Step Therapy recommendations are reviewed by a committee of U-M physicians and pharmacist to ensure safe, effective drug therapy.
COX-2s are generally considered second-line therapy for pain management, and are commonly used for arthritis pain management. They include brand name products such as Celebrex®, Vioxx®, and Bextra.
Studies have shown that COX-2 inhibitors are not superior to traditional nonsteroidal anti-inflammatory agents (NSAIDs) in controlling pain for arthritis patients. In 2003, this class of medications represented $1.3 million of the University total drug cost. The traditional NSAIDs are available at 20% of the cost of the newer COX-2 agents. Therefore, use of a generic traditional NSAID agent is recommended for controlling pain prior to using a COX-2 inhibitor. The clinical judgment for appropriate therapy rests with your physician. Your physician can review your medical history and decide the best treatment.
Prior Authorization for COX-2 inhibitors will be required for any prescription drug plan member:
- Who is under the age of 60
- Who is NOT currently taking an anticoagulant (i.e., Coumadin®, warfarin, etc.) or corticosteroid (i.e,. prednisone, dexamethasone, etc.)
- Who has NOT been previously treated with at least two prescriptions of traditional NSAIDS (i.e., Motrin®, ibuprofen, Naprosyn®, naproxen, diclofenac, etc.)
Members currently taking a COX-2 inhibitor will be ‘grandfathered’. In other words, if the claims history demonstrates a paid COX-2 claim in the last 120 days, the current claim will be paid.
More information will be available on the Benefits Office website in the near future.
The University of Michigan in its sole discretion may modify, amend, or terminate the benefits provided with respect to any individual receiving benefits, including active employees, retirees, and their dependents. Although the university has elected to provide these benefits this year, no individual has a vested right to any of the benefits provided. Nothing in these materials gives any individual the right to continued benefits beyond the time the university modifies, amends, or terminates the benefit. Anyone seeking or accepting any of the benefits provided will be deemed to have accepted the terms of the benefits programs and the university's right to modify, amend or terminate them.