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If you are an Individual or Family Member under age 65, please register here.

If you are an Medicare or Medicare Supplement member, please register here.

Walgreens Information:

Walgreens is not part of Blue Cross of Idaho's network of pharmacies for our under-65 members who have pharmacy benefits managed by CVS Caremark. Blue Cross of Idaho made this decision as part of our continuing efforts to hold down the cost of healthcare.

To obtain an accurate listing of the network pharmacies in your area, please log in as a member and click the link "Pharmacy Benefits" then select "Find a pharmacy" located under the "Order Prescriptions" menu. If you are not yet registered as a member, please click here to register as a member.

Walgreens is a part of our network of pharmacies for Medicare Advantage members, but with an additional $2 member copayment. Medicare Advantage members please call customer service at 1-888-494-2583 or TTY 1-800-377-1363 to find a pharmacy near you.

Cox-2 Therapy Guidelines

Blue Cross of Idaho has established therapy guidelines for Cox-2 drugs due to the risks involved in their use. Celebrex will be approved for use in the following situations:

  1. Patients with documented rheumatoid arthritis including patients who are on DMARDs (gold, MTX, azathioprine, cyclophosphamide, cyclosporine, sulfasalazine, hydroxychloroquine, Enbrel or Arava).
  2. Patients who have any ONE of the following risk factors:
    • patient is 60 years old or older
    • patient is taking anticoagulant (Celebrex has the potential to increase INR's in patients on warfarin.  Close monitoring of INR's is recommended in patients started on this combination.)
    • patient has documented history of complicated GI event (i.e., bleed, perforation, symptomatic ulcer)
    • patient has chronic major organ impairment (i.e., CAD, unstable angina, severe COPD, anemia, congestive heart failure, hepatic insufficiency or diabetes.)
    • patient is on chronic, systemic corticosteroid therapy
    • patient has had treatment failure on two different NSAIDs within the last 90 days
  3. Patients with familial adenomatous polyposis (FAP) - only Celebrex. 
  4. As a short-term (not more than two weeks) transitional therapy for patients undergoing a surgical procedure who are on chronic NSAIDs and fail or do not tolerate alternate analgesic therapy which also does not affect platelet function (narcotics, acetaminophen, generic Trilisate).  Typical plan would be to convert from NSAID before the procedure, then continue on the COX-2 drug after surgery to avoid bleeding complications.    
  5. Prescriptions written by rheumatologists.    

NOTE: NSAID associated dyspepsia or heartburn is not a reliable risk factor or a predictor for future clinically significant NSAID associated GI events. GERD is not a risk factor for NSAID associated complications.

 

References:

Singh G and Ramey DR. NSAID Induced Gastrointestinal Complications: The ARAMIS Perspective- 1997. J Rheumatol 1998;Vol 25 S 51:8-16.

Special Article: Recommendation for the Medical Management of Osteoarthritis of the Hip and Knee. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Arthritis and Rheumatism. September 2000. Vol 43(9): 1905-1915.

 

Quantity Limit per Prescription: COX-2 Inhibitors

If a member does not meet the above criteria, they will be able to receive a maximum of 15 units per prescription for one copay. After the initial prescription, they will be subject to the prior authorization.

 

  COX-2 Prior Authorization Form