Initially hailed as breakthrough medications, COX-2 inhibitors have steadily lost formulary status over the past 12 months, according to data compiled by Formulary Compass. Questions about their relative efficacy and side effects, cardiovascular toxicity in particular, may have contributed to reduced coverage in lower tiers.
Comparing first quarter 2002 with first quarter 2003, Celebrex (celecoxib), the first of the COX-2 agents launched in the U.S., dropped from 26 percent of covered lives on approved, Tier 1 or Tier 2 status to only 18.7 percent. From March 2002 to March 2003, prior authorization status for celecoxib climbed from 36 percent of covered lives to 44 percent (Figure 1).
Similar data are seen with Vioxx (rofecoxib) during this time frame. Approved, Tier 1 or Tier 2 status dropped from 28.8 percent of covered lives to 17.5 percent for the second COX-2 launched in the U.S. Prior authorization status rose during this time, from 37.1 percent to 43.6 percent (Figure 2).
Does this trend apply to the most recently launched COX-2 inhibitor, Bextra (valdecoxib)? With a year under its belt, valdecoxib is experiencing an increase in prior authorizations — up from 30.1 percent in March 2002 to 38.2 percent one year later (Figure 3).
This information comes from Formulary Compass, MediMedia USA's regularly updated database of approximately 3,000 managed care formularies.