Pennsaid (diclofenac sodium topical solution 2%) — Highmark
osteoarthritis knee pain
Preferred products
- generic diclofenac sodium 1.5% topical solution
- diclofenac sodium 1% gel
- oral generic NSAIDs (one must be oral diclofenac)
Initial criteria
- age ≥ 18 years
- diagnosis of osteoarthritis knee pain (ICD-10: M17.9)
- therapeutic failure, contraindication, or intolerance to three plan-preferred formulary, oral generic NSAIDs, one of which must be oral diclofenac
- therapeutic failure to one of the following plan-preferred products: generic diclofenac sodium 1.5% topical solution OR prescription generic diclofenac sodium 1% gel
Reauthorization criteria
- member continues to use the medication for an FDA approved indication
- prescriber attests that the member has experienced positive clinical response to therapy
Approval duration
12 months