Limited coverage drugs – celecoxib

Last updated on August 7, 2024

Generic name

celecoxib

Strength

100 mg, 200 mg

Form

capsule

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

  • 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)