Celebrex Alternatives

Medicare Set-Aside Blog on December 6, 2012
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Celebrex loses its patent in 2014 and will almost certainly be available in a generic formulation at that time. 

Currently, AWPs are $5.7379 for the 200mg capsule and $3.4982 for the 100mg capsule. So, the allocation for a patient taking 100mg twice daily would be $2,518.70 per year of life expectancy. The allocation for a patient taking 200mg once daily would be $2,065.64 per year of life expectancy. 

Although recent studies call this claim into question, Celebrex is marketed for patients who have a previous history of stomach/intestinal problems such as ulcers, reflux, etc. For patients with a history of GI problems, Celebrex is often preferred to other, much less expensive anti-inflammatory agents such as ibuprofen or naproxen. Celebrex is often inappropriately prescribed for patients without such a history, however. So, the first question to ask for a patient who is prescribed Celebrex is whether or not he/she has such a history. 

Most cost-effective alternatives to Celebrex include Mobic (meloxicam), ibuprofen and naproxen. Potential cost savings for these agents:

Mobic 15mg per day = $76.03 per year of life expectancy 
Ibuprofen 600mg three times per day = $40.39 per year of life expectancy
Naproxen 500mg twice daily = $756.29 per year of life expectancy 

If the physician has reservations about switching from Celebrex to a different anti-inflammatory due to potential GI problems, another suggestion would be to prescribe a GI protective agent such as Pepcid, Tagamet or Prilosec along with the anti-inflammatory. We often see ibuprofen or naproxen prescribed in conjunction with Prilosec or Pepcid to protect against stomach problems. Many of these drugs are available over-the-counter and are not Medicare covered in that instance. So, the cost can be excluded from the allocation altogether if the physician prescribes a drug/dose that is available in an over-the-counter preparation. 

Take away? Don’t just authorize Celebrex without considering alternatives.