Elyxyb (celecoxib) Oral Solution - PA, NF
Indications for Prior Authorization
Elyxyb (celecoxib) Oral Solution
-
For diagnosis of Migraine
Indicated for the acute treatment of migraine with or without aura in adults.Limitations of use: ELYXYB is not indicated for the preventive treatment of migraine.
Criteria
Elyxyb
Prior Authorization
Length of Approval: 12 Month(s)
- Diagnosis of migraine with or without aura AND
- Trial and failure, contraindication or intolerance to two of the following generics:
- Almotriptan tablet
- Eletriptan tablet
- Frovatriptan tablet
- Naratriptan tablet
- Rizatriptan tablet/rizatriptan orally dissolving tablet (ODT)
- Sumatriptan tablet/nasal spray
- Zolmitriptan tablet/zolmitriptan ODT
Elyxyb
Non Formulary
Length of Approval: 12 Month(s)
- Diagnosis of migraine with or without aura AND
- Paid claims or submission of medical records (e.g., chart notes) confirming trial and failure, contraindication or intolerance to two of the following generics:
- Almotriptan tablet
- Eletriptan tablet
- Frovatriptan tablet
- Naratriptan tablet
- Rizatriptan tablet/rizatriptan orally dissolving tablet (ODT)
- Sumatriptan tablet/nasal spray
- Zolmitriptan tablet/zolmitriptan ODT
P & T Revisions
2024-04-24, 2023-05-03, 2022-05-09
References
- Elyxyb Prescribing Information. Dr. Reddy’s Laboratories Limited. Telangana, India. October 2021.
Revision History
- 2024-04-24: 2024 annual review. Background changes.
- 2023-05-03: Annual review - no changes.
- 2022-05-09: New PA program for Elyxyb.
HEALTHY LIVING