TIVORBEX (indomethacin)

TIVORBEX (indomethacin)

SELF ADMINISTRATION - Oral

Indications for Prior Authorization:

• Treatment of mild to moderate acute pain in adults

Patients must meet the following criteria for the indication(s) above:

• Used for the treatment of mild to moderate acute pain, AND
• Patient is 18 years of age or older, AND
• Chart note documentation is provided and confirms: patient has tried and failed two preferred generic prescription strength oral NSAIDs (nonsteroidal antiinflammatory drugs), one of the two must be generic indomethacin capsules OR there is a medically appropriate reason why generic alternatives cannot be tried

Dosing:

• 20 mg three times daily OR 40 mg two or three times daily