ibuprofen/famotidine tablets — Cigna
treatment of acute and chronic conditions requiring analgesic and anti-inflammatory activity
Preferred products
- prescription ibuprofen (oral)
- prescription cimetidine (oral)
- prescription famotidine (oral)
- prescription nizatidine (oral)
- prescription ranitidine (oral)
Initial criteria
- Patient has tried one prescription oral ibuprofen product (Step 1c) AND one prescription oral histamine H2 receptor antagonist (Step 1c) prior to use of ibuprofen/famotidine tablets (Step 2c)
Approval duration
1 year