FENORTHO (fenoprofen)

FENORTHO (fenoprofen)

SELF ADMINISTRATION - Oral

Indications for Prior Authorization:

• Relief of mild to moderate pain in adults
• Relief of the signs and symptoms of rheumatoid arthritis
• Relief of the signs and symptoms of osteoarthritis

Patients must meet the following criteria for the indication(s) above:

• Used for the relief of mild to moderate pain in adults, or rheumatoid arthritis, or osteoarthritis, AND
• Chart note documentation is provided and confirms: patient has tried and failed two preferred generic prescription strength oral NSAIDs (nonsteroidal antiinflammatory drugs), one of the two must be generic Fenoprofen tablets OR there is a medically appropriate reason why generic alternatives cannot be tried

Dosing:

• Mild to moderate pain:
  • 200 mg given orally every 4 to 6 hours as needed
• Rheumatoid arthritis or osteoarthritis:
  • 400 to 600 mg orally 3 or 4 times a day
  • Maximum total daily dosage: 3,200 mg