How are insurance company formularies derived? One hopes it’s not by individuals with the same training as the one who asked why Celebrex was prescribed for arthritis rather than an antidepressant. Given past insurance company demands that the indication for a prescribed treatment have FDA approval, it’s intriguing that use of Lyrica (approved for the indication) has been refused in favor of a medication that lacks FDA approval for that indication.
One wonders why these medically questionable and fiscally irresponsible decisions have been allowed to persist. Perhaps the insurance companies do not expect to be involved with specific patients long enough for the extra toxicity to manifest. One wonders if such behavior, which deprives compromised individuals of access to care, represents a violation of the Americans with Disabilities Act.
Sincerely,
Bruce Rothschild, MD
Professor of Medicine, Northeast Ohio
Medical University and Indiana Regional
Medical Center, Indiana, Pa.
References
- de Melo Gomes JA. The safety of Arthrotec in patients with rheumatoid arthritis or osteoarthritis: An assessment of the upper gastrointestinal tract by endoscopy. Scand J Rheumatol Suppl. 1992;96:23–31.
- Goldstein JL, Larson LR, Yamashita BD. Prevention of nonsteroidal anti-inflammatory drug-induced gastropathy: Clinical and economic implications of a single-tablet formulation of diclofenac/misoprostol. Am J Manag Care. 1998 May;4(5):687–697.
- Silverstein FE, Graham DY, Senior JR, et al. Misoprostol reduces serious gastrointestinal complications in patients with rheumatoid arthritis receiving nonsteroidal anti-inflammatory drugs. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 1995 Aug 15;123(4):241–249.
- Rothschild BM, Helbling M. Is coadministration of alendronate and nonsteroidal antiinflammatory drugs an unacceptable risk? J Clin Rheumatol. 2002;8:288–290.
