Lidoderm Patch Criteria

[andrew.maiorini]

What criteria are used for determining the appropriateness of Lidoderm patch use? For those that have criteria, what consideration does the criteria give to off-label uses?

[Nochmar]

We cover on formulary, unrestricted.

As a rule, we do not restrict pain meds to on-label indications. i.e. we would allow PA something like Lyrica for a patient using it for headache or back pain.

[david.calabrese]

Here are our criteria:


• The diagnosis or indication is neuropathic pain/post-herpetic neuralgia.
AND
• The patient has had a documented side effect, allergy, treatment failure or contraindication to TWO drugs in the tricyclic antidepressant (TCA) class and/or anticonvulsant class
AND
• The patient has had a documented side effect, allergy, treatment failure or contraindication to Lyrica
OR
• The patient has a medical necessity for a transdermal formulation (ex. dysphagia, inability to take oral medications)

Requests for coverage for other indications are handled on a case by case basis by our clinical pharmacist staff through our medical justification process. We usually require providers to show documented scientific evidence in support of other off-label uses.

[chantell.reagan]

In an analysis of 10 regional or national plans, 9 plans cover Lidoderm on either a 2nd or 3rd tier, without prior authorization. Only 1 plan considers Lidoderm to be a non-preferred product:Aetna Clinical Policy bulletin: Dermatologic Anesthetics

[jacqueline.kostick]

According to the evidence-based guidelines for treatment of neuropathic pain issued by the International Conference on the Mechanisms and Treatment of Neuropathic Pain, Lidoderm (lidocaine patch 5%) is recommended as a first-line medication for neuropathic pain. In addition, tricyclic antidepressants (TCAs), opioid analgesics, and tramadol are also recommended as first-line neuropathic pain relief options.

The guidelines state that in the past, TCAs had been considered first-line treatment for postherpetic neuralgia; however, currently, gabapentin and the lidocaine patch 5% are considered first-line treatment, because they are FDA-approved for this use and have superior tolerability profiles.

Also, several review articles summarize the use of lidocaine patch 5% for postherpetic neuralgia.
In addition, review articles have suggested the possible off-label benefit of the lidocaine patch for the management of other neuropathic conditions, including diabetic peripheral neuropathic pain. The lidoderm patch has also been suggested for HIV-related neuropathy, but one study reported limited success.

Sources:
1. Dworkin RH, O'Connor AB, Backonja M, et al. Pharmacologic management of neuropathic pain: evidence-based recommendations. Pain 2007 Dec 5; 132(3):237-51.

2. Trying SK. Management of herpes zoster and postherpetic neuralgia Journal of the American Academy of Dermatology. (57) 6 Suppl; 2007 Dec.

3. Schmader K. Herpes Zoster and Postherpetic Neuralgia in Older Adults. Clinics in Geriatric Medicine. 23; 2007 Aug.

3. Vinik AI, Strotmeyer ES, Nakave AA. Diabetic Neuropathy in Older Adults. Clin Geriatr Med 24 (2008) 407-35.

4. Unger J, Cole BE. Recognition and Management of Diabetic Neuropathy. Primary Care: Clinics in Office Practice. 34; 2007 Dec.

5. Gonzalez-Duarte A. Diagnosis and management of HIV-associated neuropathy. Neurol Clin. 2008 Aug; 26(3): 821-32.

6. Knotkova H. Adjuvant analgesics. Anesthesiol Clin. 2007 Dec; 25(4): 775-86.