Coverage Decisions for Drugs

Duloxetine (Cymbalta)

Duloxetine is a serotonin and norepinephrine reuptake inhibitor and a weak dopamine reuptake inhibitor approved for the treatment of major depressive disorder (MDD), generalized anxiety disorder (GAD), diabetic peripheral neuropathic pain, fibromyalgia and chronic musculoskeletal pain. In general, the coverage of duloxetine depends on appropriateness for the accepted conditions. Duloxetine is a nonpreferred antidepressant on the Preferred Drug List (please see covered alternatives at Selected PDL for Workers).

Coverage decision for chronic musculoskeletal pain

The department or insurer does not cover duloxetine for chronic musculoskeletal pain, including osteoarthritis pain and chronic low back pain. Covered alternatives include preferred non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen and skeletal muscle relaxants. See the Outpatient Drug Formulary for a list of alternatives.

Of the five studies submitted to the U.S. Food and Drug Administration (FDA) for approval of this indication, three studies excluded workers’ compensation patients from the studied population. In addition, there was conflicting evidence of efficacy for chronic low back pain and osteoarthritis pain and a high incidence of adverse events.


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