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febuxostat — Point32Health

chronic management of hyperuricemia in adult patients with gout

Preferred products

  • allopurinol

Initial criteria

  • The patient has had a trial of a Step-1 or Step-2 medication within the previous 180 days as evidenced by a paid claim under the prescription benefit administered by the plan
  • OR The patient has had a trial of a Step-1 or Step-2 medication as evidenced by physician documented use, excluding the use of samples
  • OR Requesting physician has documented that the patient has a contraindication to or intolerance to all Step-1 medications
  • The plan may cover medications on Step-2 if a patient has received a non-formulary medication containing the same therapeutic ingredient as a lower step agent, as evidenced by physician documented use