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Drug - Iprivask® (desrudin) [Marathon Pharmaceuticals LLC]

November 2014

Therapeutic area - Direct thrombin inhibitors

Approval criteria

  • Patient is undergoing or has had elective hip replacement surgery AND
  • Patient has a history of heparin-induced thrombocytopenia OR
  • Patient is intolerant to low-molecular weight heparins

Quantity limits

Coverage will be limited to 12 days of therapy. Number of doses given in the hospital must be supplied at time of prior authorization request.


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

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