Famotidine/ibuprofen tablet (generic for Duexis) — Point32Health

Initial criteria

• Documentation that member is using this agent for relief of signs and symptoms of osteoarthritis or rheumatoid arthritis
• Member is at risk of developing NSAID associated gastric ulcers
• Member has tried and failed therapy with taking the individual components (famotidine and ibuprofen) concurrently, or the provider indicates clinical inappropriateness of treatment with the individual ingredients used together
• Documentation of treatment failure or contraindication to another generic H2 antagonists (e.g., cimetidine) in combination with two different NSAIDs (e.g., naproxen, meloxicam)

Approval duration

6 months