Naproxen/esomeprazole tablet (generic for Vimovo) — Point32Health
relief of signs and symptoms of rheumatoid arthritis
Initial criteria
- Documentation that member is using this agent for relief of signs and symptoms of osteoarthritis, rheumatoid arthritis, or ankylosing spondylitis
- Member is at risk of developing NSAID associated gastric ulcers
- Member has tried and failed therapy with taking the individual components (naproxen and esomeprazole) concurrently, or the provider indicates clinical inappropriateness of treatment with the individual ingredients used together
- Documentation of treatment failure or contraindication to two generic PPIs (e.g., omeprazole, pantoprazole, lansoprazole) in combination with two different NSAIDs (e.g., ibuprofen, meloxicam)
Approval duration
6 months