Celebrex® Infromative Articles Health Plans Are Cautious About Celebrex
Best's Review - Life-Health Insurance Edition v99, n10 (Feb, 1999):14 (1 pages).COPYRIGHT 1999 A.M. Best Company Inc. Despite criticism from some physicians, health plans are taking a
cautious approach to their coverage of Celebrex, the anti-inflammatory drug approved by the Food and Drug Administration in January. Neither UnitedHealthcare nor Kaiser Health Plan Inc. in
California has included the arthritis medication on its list of approved or preferred drugs. UnitedHealthcare has given the drug the lowest reimbursement rate it offers. Kaiser will only cover
the drug if a physician indicates that the particular drug is medically necessary UnitedHealthcare works on a three-tiered system of copays: generic drugs cost $7 per prescription, brand names
on the preferred list cost $12, and brand drugs not on the preferred list cost $25, said Phil Soucheray, UnitedHealthcare spokesman. The drug has not come up for evaluation yet. If it is shown to
be as effective as existing drugs and to have fewer side effects, there is always the possibility that it could be put on the preferred list. "Normally it takes several weeks and several
months before a drug makes it under the formulary" said Tom Debley, Kaiser spokesman. Celebrex still has to be reviewed and in the meantime Kaiser physicians can prescribe it when medically
necessary The patient would pay out-of-pocket, but at an amount less expensive than in an out-of-network pharmacy, he said. Some studies suggest the drug has less gastrointestinal
complications than other anti-inflammatory medications.
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