Flector — Blue Cross Blue Shield of Alabama

Preferred products

• generic topical NSAID

Initial criteria

• The patient has a diagnosis of acute pain due to minor strains, sprains, and/or contusions AND
• ONE of the following:
• • The patient has tried and had an inadequate response to a generic topical NSAID agent within the past 90 days OR
• • The patient has an intolerance or hypersensitivity to a generic topical NSAID agent OR
• • The patient has an FDA labeled contraindication to ALL generic topical NSAID agents that is not expected to occur with the requested agent AND
• The patient does NOT have any FDA labeled contraindications to the requested agent

Approval duration

3 months