Drug - Soma 250 mg tablet(carisoprodol) [Medpointe]
Therapeutic Area - Muscle Relaxant
Patients have tried at least tizanidine tablets and cyclobenzaprine without efficacy benefit AND
There is submitted clinical documentation of intolerance after taking other generically available forms of carisoprodol or carisoprodol/aspirin combination tablets AND
Patient has shown an efficacy response to carisoprodol 350 mg AND
This drug is prescribed for only short term (2 to 3 weeks of use) AND
The prescriber is made aware of the price differential and that the recipient will have to pay a $3 co-pay rather than a $1 co-pay AND
Grandfathering criteria does not apply
Quantity limit of 84
FDA approved indication
The relief and discomfort associated with acute, painful musculoskeletal conditions in patients 16 years and older.
Treatment should be limited to periods of less than 2 or 3 weeks.
Soma was evaluated for the relief of acute, idiopathic mechanical low back pain in two, 7-day, double blind, randomized, multicenter, placebo controlled, US trials and found to be equal in efficacy to carisprodol 350mg with a slightly smaller incidence of drowsiness.
Soma 250 mg, is about $10.00 per day more expensive than carisoprodol 350 mg ($0.12/tab) or carisoprodol/asa 200/325 ($0.10/tab).
MHCP Provider Call Center 651-431-2700 or 800-366-5411