University Of Michigan Benefits Office

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 Web site in the near future.