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Eliquis

Drug - Eliquis [BMS/Pfizer]

August 2016

Therapeutic area - Growth Hormone Releasing Factor

Approval criteria

  • Patient has diagnosis of nonvalvular atrial fibrillation AND
  • Prior stroke (ischemic or unknown), transient ischemic attack (TIA) or non-CNS system embolism OR
  • 2 or more of the following risk factors; hypertension, heart failure or left ventricular ejection fraction ≤40%, diabetes mellitus AND
  • Patient has a documented clinical intolerance/contraindication to warfarin OR
  • Patient has tried, at least, a 2-month trial of warfarin and, despite standard of care, was not well controlled

OR

  • Patient has had knee or hip replacement surgery AND
  • Treatment will be limited to 12 days with knee replacement surgery OR
  • Treatment will be limited to 35 days with hip replacement surgery

OR

  • Patient has a diagnosis of deep vein thrombosis (DVT) OR pulmonary embolism (PE)
  • Patient has a documented clinical intolerance/contraindication to warfarin OR
  • Patient has tried, at least, a 2-month trial of warfarin and, despite standard of care, was not well controlled

Quantity limits

68 tablets per 34-day supply

Background information

ELIQUIS is a factor Xa inhibitor anticoagulant indicated:

  • To reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation 
  • For the prophylaxis of deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE), in patients who have undergone hip or knee replacement surgery
  • For the treatment of DVT and PE, and for the reduction in the risk of recurrent DVT and PE following initial therapy

Questions?

MHCP Provider Call Center 651-431-2700 or 800-366-5411

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