Limited Coverage Drugs - naproxen EC

Generic Name

naproxen

Strength

250 mg, 375 mg, 500 mg

Form

enteric-coated tablet

 

Special Authority Criteria

Approval Period

For the treatment of patients who have a:

  • Diagnosis of rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, gout, or lupus

OR

  • Treatment failure on optimal doses of, or intolerance to, both ibuprofen and naproxen.

Indefinite

Practitioner Exemptions

Practitioners in the following specialty are not required to submit a Special Authority request form for coverage:

  • Pediatrics
  • Pediatric cardiology
  • Pediatric general surgery
  • Physical medicine and rehabilitation
  • Rheumatology

Special Notes

  • Treatment failure on or intolerance to the specific medications listed in the above criteria is required.

Special Authority Request Form(s)