State Health Plan: Topical Diclofenac Products Step Therapy Program
Starting November 1, 2010, topical diclofenac products will require a coverage review for all claims. These products include: Flector® Patch (diclofenac epolamine 1.3%); Pennsaid® Topical Solution (diclofenac sodium 1.5%); and Voltaren® Gel (diclofenac sodium 1%).
The State Health Plan is implementing this program to maintain an affordable prescription drug benefit and to encourage the use of traditional non-steroidal anti-inflammatory drug (NSAID) therapy as first-line therapy, if appropriate.
Coverage will be provided in situations where the patient has previously experienced failure, or intolerance to treatment, with at least three different over-the-counter and prescription oral, traditional NSAIDs, unless the patient is unable to take any other oral agents. Coverage will not be provided in the presence of concurrent therapy with oral NSAIDs or celecoxib.
Providers may call Medco toll-free at 1-800-417-1764, from 8 a.m. to 9 p.m., Eastern Time, Monday through Friday, to request a review. Members will be responsible for the full cost of the prescription if the provider does not receive approval during the coverage review.
Please visit the Plan website at www.shpnc.org for further information.