Diclofenac (Pennsaid)

SELF-ADMINISTRATION - TOPICAL

Indications for Prior Authorization:

  • Treatment of the pain of osteoarthritis of the knee(s)

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

  • Diagnosis of knee osteoarthritis, AND
  • 18 years or older, AND
  • Patient has tried and failed 2 preferred oral prescription NSAIDs, AND
  • Patient has tried and failed diclofenac 1% gel

Dosing:

  • 1.5% solution: apply 40 drops to each affected knee 4 times daily
  • 2% solution: apply 2 pump actuations to each affected knee twice daily

Approval:

  • 1 year

Last review date: June 5, 2017